Ann, a lawyer in San Francisco, had been to see her doctor, but felt frustrated. When she described her symptoms, fatigue, weight loss without trying, and just not feeling well, her doctor said she needed to relax more, or maybe take a vacation. The doctor shrugged off Ann's concerns, saying she was young and in her prime and that she had nothing to worry about.
When Ann's symptoms worsened, she went to another doctor recommended by a friend and was diagnosed with lupus, an autoimmune disease. With the cause of her symptoms finally identified, she was able to begin a treatment plan that helped control the symptoms that were upsetting her life.
The term autoimmune disease encompasses more than 80 different, serious chronic illnesses. Many are rare, but as a group they plague more than 20 million Americans. Autoimmune diseases may be a leading cause of death in young and middle-aged women.
Ann's experience is not uncommon. The American Autoimmune Related Disease Association (AARDA) found that more than half of patients with autoimmune diseases had been labeled hypochondriacs or chronic complainers during the earlier stages of their illnesses. This may be due to the nature of the symptoms: they are vague, tend to come and go, and are often hard to describe. Additionally, autoimmune diseases tend to strike women during their childbearing years, when a woman typically looks healthy.
Getting a correct diagnosis may be difficult in the beginning stages, but it is imperative. The inability to quickly identify an autoimmune disease can take a serious toll on a person, both physically and mentally.
Researchers do not know why more women suffer from autoimmune diseases. In fact, little is known about what causes autoimmune diseases. It appears that hormones may play a role. The involvement of hormones has been hypothesized because the expression of autoimmune diseases and their symptoms seems to be related to changes in hormone levels.
"No study clearly states that hormones cause autoimmune diseases," says Virginia Ladd, president and founder of the AARDA, "but a connection between the two is evident. If you look at the number of diagnoses after puberty and before menopause, you see a much higher rate than before or after these events. Also, some diseases suddenly improve during pregnancy, with symptoms re-emerging after delivery, and others may get worse with pregnancy."
"The research is in its infancy, and although the inter-relationship between hormones and autoimmune diseases is acknowledged, most aspects of this relationship are not clearly understood," Ladd explains.
The immune system defends the body's health by fighting foreign invaders. The key to proper functioning of the immune system is its ability to distinguish "self" from "non-self" tissues. Autoimmune disorders occur when the control process is thrown out of whack and the immune system reacts to normal, self body tissue. The body actually attacks its own tissues and can destroy body tissues, change organ function, or cause abnormal organ growth.
Is It Genetic?
Genetics play a role in the development of the disease. Numerous genes are involved and work together to increase a person's susceptibility. You may inherit genes that make you more likely to get an autoimmune disease. A combination of genes and other factors can trigger an autoimmune disease to start.
Autoimmune diseases tend to cluster in families. Interestingly, though, the clusters manifest as different autoimmune diseases: a mother may have diabetes; a daughter may have lupus; and a grandmother may have rheumatoid arthritis.
Noel Rose, MD, PhD, a professor at Johns Hopkins University and expert in the field of autoimmune diseases, states in a paper presented at an AARDA conference that "genetic components represent something on the order of half of the risks. If you have a genetic predisposition to autoimmunity, you may have two or five times as much chance of developing autoimmunity as someone else."
Is It Something in the Environment?
There appear to be agents in the environment that trigger the disease or exacerbate symptoms. These agents include:
Although researchers believe there may be some association between autoimmune diseases and the environment, the relationship is not clear and much remains to be discovered.
Most autoimmune diseases are chronic and few can be cured. Treatment focuses on reducing the severity of the symptoms. In some cases, symptoms may be reduced with steroidal or other anti-inflammatory medicines. With severe diseases, it may be necessary to suppress the immune system with immunosuppressive medicines.
Until effective treatment or preventive measures are discovered, experts say that learning to cope with the disease is the best strategy. Developing coping mechanisms can be challenging and even frightening. You may not only question your own ability to cope but also the ability of those around you.
The AARDA highlights the following two areas on which to focus your coping efforts:
It is important to not be intimidated by the medical profession; your doctor is your partner. Ask questions and fully understand your individual condition and treatment plan. Be an active member in the development of your treatment plan. Never be afraid to get a second opinion.
Mentally, you can expect to feel several different emotions, and it may seem like a roller coaster. The way you handle the emotional cascade is personal—find the way that works for you. It may be helpful to enlist the support of those around you, remembering that you are not alone. In fact, many people find joining a support group very helpful. And, most importantly, give yourself and your family time to adjust, since chronic illnesses have many ups and downs and can be emotionally draining.
American Autoimmune Related Disease Association
Lupus Foundation of America
Women's Health Matters
Autoimmune diseases fact sheet. Department of Health and Human Services Women's Health website. Available at: http://www.womenshealth.gov/publications/our-publications/fact-sheet/autoimmune-diseases.html. Updated July 16, 2012. Accessed June 19, 2013.
Autoimmune disease in women. American Autoimmune and Related Diseases Association website. Available at: https://www.aarda.org/women_and_autoimmunity.php. Accessed June 19, 2013.
Coping with autoimmunity. American Autoimmune and Related Diseases Association website. Available at: https://www.aarda.org/coping.php. Accessed June 19, 2013.
Rose, NR. Autoimmunite disease: The common thread. American Autoimmune and Related Diseases Association website. Available at: http://www.aarda.org/common_thread_art.html. Accessed June 19, 2013.
The cost burden of autoimmune disease: The latest on the front in the war on healthcare spending 2011. American Autoimmune and Related Diseases Association website. Available at: http://www.aarda.org/pdf/cbad.pdf. Accessed June 19, 2013.
Walsh SJ, Rau LM. Autoimmune diseases: a leading cause of death among young and middle-aged women in the United States. Am J Public Health. 2000;90(9):1463-1466.
Last reviewed June 2013 by Michael Woods, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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