Why women are more susceptible to autoimmune diseases: Is the X chromosome at play?
Lupus, rheumatoid arthritis, Celiac Disease, multiple sclerosis often impact women more
What happens when the body goes to war with itself? That's the crippling reality of autoimmune diseases, where stories are in abundance but a cure remains elusive.
One day at the age of 15, Deeksha Mehra, a Dubai-based media professional woke up with red, swollen fingers and a pain that slowly spread to her elbows, knees and ankles within days. It has been 13 years of this particular autoimmune disease: She is wearily used to the exhaustion, fatigue, constant doctor visits, blood tests, and the agonising joint pains that don’t let her sleep at night. On some days, she wakes up with “butterfly” rashes on her face.
Nevertheless, she tries to take it in her stride. “I’ll keep fighting lupus; it’s just something that I have to live with,” she says cheerfully.
It’s not something you can come to terms with overnight, says Mehra, who is 28 now. “I do get frustrated that I have to think twice before going out to have fun: I never know if I might wake up the next morning with an inflammation of sorts,” she says.
While Mehra struggles with Lupus, Kate Shaw a Dubai-based British expat, was diagnosed recently with Hashimoto Disease, an affliction of the thyroid gland. “Sometimes it just gets too much to leave the bed,” she says. As she explains, Hashimoto's fatigue, weight gain, and the development of nodules on the thyroid gland are all the signs of the disease. Another Dubai-based expat, who prefers not to be named, suffers from the same disease explains the anxiety over nodules, "My nodules are benign, but I still have to get it checked, regularly,” she says.
Understanding autoimmune diseases
In simple words, an autoimmune disease is when your immune system mistakenly turns against you.
As Muawia Aloliwi, a Dubai-based specialist pediatrician explains, autoimmune diseases represent a broad category of medical conditions characterised by the body’s immune system attacking its own cells. “Normally, the immune system is meant to protect the body against foreign attackers, such as bacteria and viruses. However, in the case of autoimmune diseases, it is unable to distinguish between foreign cells and the body’s own cells,” he explains. This results in an inappropriate immune response against the body’s tissues.
And so, an autoimmune disorder could result in the destruction of a body tissue, the sudden growth of an organ, and dysfunctional changes in organ functions, explains Cynthia Hale, a Dubai-based endocrinologist. A wide range of organs and tissues can be affected by the disease, including blood vessels, connective tissues, endocrine glands, joints, muscles, red blood cells and the skin.
While autoimmune diseases can affect anyone, research shows they are more common in women.
Why are autoimmune diseases more common in women?
Autoimmune diseases are now the fifth leading cause of death in women younger than 65, adds Hale. Women account for an estimated 78 per cent of people, who suffer from these disorders, that include lupus, multiple sclerosis, rheumatoid arthritis and other illnesses where the body’s immune system attack its own cells and tissues.
It’s still a mystery why women are more likely to be plagued by autoimmunity, but researchers have several theories. According to a research article Why Nearly 80 Percent of Autoimmune Sufferers Are Female, published on the medical site The Scientific Researcher, many of these conditions begin to appear in women after life-changing transitions. For instance, lupus and multiple sclerosis, can emerge during the childbearing years. Rheumatoid arthritis usually arises after menopause. Several autoimmune changes take place during pregnancy.
Since women have two X chromosomes compared to one in men, this could partly explain the increased incidence in females...
As Hale and Aloliwi explain, the reason behind these autoimmune changes can be brought down to the turbulent hormonal landscape. These life-impacting transitions involve several changes in estrogen, progesterone and testosterone. “Estrogen levels increase during puberty and pregnancy,” explains Hale. As the levels of estrogen influences the immune system, the fluctuations enhance the immune response. This increases the risk of developing an autoimmune condition.
Apparently genetic factors also play a crucial role in autoimmune diseases, as certain genes that increase the susceptibility to autoimmune diseases are found on the X chromosome, adds Aloliwi. “Since women have two X chromosomes compared to one in men, this could partly explain the increased incidence in females,” he says. Moreover, environmental factors like diet, exposure to certain chemicals, and viral infections might interact with genetic predispositions to trigger autoimmune diseases. These triggers can activate the immune system inappropriately, leading to chronic inflammation and tissue damage.
The role of estrogen and progesterone:
Hale breaks it down further:
• Estrogen: This hormone regulates the growth, development and physiology of the reproductive system. It also has a direct impact on blood sugar, cholestrol, circulation and blood flow. Moreover, it exercises a direct influence over the immunity genes. It latches on to the gene that is instrumental for releasing interferon gamma, which is a chemical that induces immune responses against pathogens. However, it can also escalate the autoimmune response. Estrogen activates cells that release antibodies, protein that mark and attack foreign substances. However, in some cases, it can also release autoantibodies that attack cells made by the body.
• Progesterone: A hormone that plays a crucial role in the reproductive system, progesterone supports menstruation and helps maintain the early stages of pregnancy. The main function of progesterone is to prepare the endometrium, which is the lining of a uterius, for a fertilized egg to implant and grow.
Progesterone is also deeply linked with the immunity system. Many crucial mmune cells, feature receptors for progesterone on their surface. As the progesterone latches on to receptors, it encourages the body to have an immune response that includes the production of both antibodies and antibodies. This is known as the Th2 immune response. This differers from Th1 immune responses, which keep the body away from antibody manufacturing and instead activate cells that attack other cells directly. During pregnancy, there is a rise in progesterone. The symptoms of rheumatoid arthritis and multiple sclerosis reduce, as they are driven by Th1 and not Th2. However, women who have multiple sclerosis are at risk of having a relapse after delivery, and that is associated with the constant fluctuation of hormones.
The kinds of autoimmune diseases that more commonly affect women
There are more than 100 known autoimmune disorders, which have different manifestations and target different organs and tissues in the body, explains Zainab Moalla from Neo Health. "There are multiple common autoimmune diseases, such as Psoriatic arthritis, Rheumatoid arthritis (RA), Sjögren’s syndrome, and Systemic lupus erythematosus (Lupus, SLE)," she explains. Moreover, inflammatory bowel diseases (Crohn’s disease, Celiac disease, Ulcerative colitis), endocrine system diseases (Graves’ disease, Hashimoto’s thyroiditis, Addison’s disease), and skin diseases (Dermatomyositis, Psoriasis) can also be found in great abundance.
There are more than 100 known autoimmune disorders, which have different manifestations and target different organs and tissues in the body. There are multiple common autoimmune diseases, such as Psoriatic arthritis, Rheumatoid arthritis (RA), Sjögren’s syndrome, and Systemic lupus erythematosus (Lupus, SLE)...
Many of these can be categorised into systemic autoimmune diseases, and organ-specific autoimmune diseases. “Systemic autoimmune diseases, like systemic lupus erythematosus (SLE) and rheumatoid arthritis, affect multiple organs and tissues throughout the body. Organ-specific autoimmune diseases, such as type 1 diabetes and multiple sclerosis, predominantly target specific organs or tissues,” explains Aloliwi.
The different kinds of diseases:
The common diseases are:
Rheumatoid Arthritis: Rheumatoid arthritis (RA) refers to a disease in which the immune system attacks joint linings throughout the body, explains Nishi Mehta, a Dubai-based rheumatologist. A person suffering from rheumatoid arthrisis will be faced with painful, stiff, swollen, deformed joints. This chronic inflammation over time can affect the heart, lungs, eyes, which increases the risk of disability and death.
Multiple Sclerosis: This is a disease that affects the spinal cord and brain. In this case, the immune system attacks the protective coating around the nerves. This leads to paralysis, tremors and numbness, explains Hale.
Celiac Disease: This occurs when your immune system attacks your intestinal lining after consumption of gluten. This leads to infertility, miscarriages, fatigue and rashes.
Alopecia areata: In this case, your hair follicles are under attack, explains Aloliwi. It leads to patchy hair loss and can upset a person’s image.
Sjögren's Syndrome: The tear glands and salivary glands are under attack. As a result, a person can have trouble swallowing, experience dryness in their eyes and mouth, and have several dental cavities.
Systemic Lupus Erythematosus (SLE): This affects the primary organs like the heart, skin, lungs, kidneys, joints. A person experiences fever, weight loss, butterfly rashes, sensitivity to the sun and chest pain.
How can it be treated?
There is no cure as yet for autoimmune diseases, nevertheless there are different treatments that can prevent the flare-ups of the symptoms. “Understanding and managing autoimmune diseases can be challenging due to their diverse manifestations and the individual nature of the immune response in different patients,” explains Aloliwi.
These diseases can be quite different from each other, yet many of them share common symptoms such as fatigue, frequent fevers, joint pain and swelling, skin problems, stomach pain, and swollen glands. The treatment goal is to regulate the immunologic response and relieve symptoms, explains Moalla.
“While these treatments can be effective in managing symptoms and preventing disease progression, they also carry risks, such as increased susceptibility to infections,” Aloliwi adds.