Global Health Asia-Pacific May 2022 May 2022 - Page 49

Autoimmune Disease

Women more likely to bear the brunt of autoimmune diseases

Immune system dysfunctions can be highly debilitating but there ’ s little awareness about them

It all started with pain in the knees and the jaw that came and went .

“ I was going through a stressful time in my life , work-wise , so I thought ‘ I ’ m just stressed , probably the pain will go away when this period is over ,’” recalled Nicole Chan , a Singaporean woman in her 30s , in an interview with Global Health Asia-Pacific .
Instead , after just a few months , the pain intensified to an agonising point where Chan was struggling to walk , eat , or dress herself . Suspecting rheumatoid arthritis ( RA ) — an autoimmune disease where the immune system mistakenly attacks the body , typically causing inflammation in the joints and painful swelling — her general practitioner referred her to a specialist who confirmed the diagnosis after running some tests .
This catapulted her into a two-year-long ordeal to find a suitable drug treatment to keep the disease at bay . When she finally found a combination of medicine and lifestyle adjustments that worked , it gave her the respite she was looking for from the constant pain . “ I felt so much better immediately , and I wasn ’ t in as much pain after that ,” she said . “ But I ’ m still wary of high impact movements like jumping because my joints are still very sensitive to the point where if I go down the stairs , landing wrongly on an ankle would make it really sore . I still have to be very careful and watch what I do .” Fatigue is also an issue for her , and she has to plan how she spends her energy ahead of time so that she can get things done . On top of that , she has limited mobility in her wrists , which is not helped by the fact that she has to do a lot of computer work .
Chan ’ s experience epitomises the difficulties caused by some autoimmune diseases , including RA and lupus , chronic conditions that don ’ t get the same headlines as other more common long-term illnesses like cancer and diabetes but can be as devastating . They also mostly affect women .
For instance , about one percent of the population in Singapore is believed to have RA , with women making up roughly 75 percent of patients . In lupus , the sex ratio is even starker . For example , in the United States ,
90 percent of the roughly 200,000 people with the disease are estimated to be women . An immune-driven inflammation , it can damage not only the joints but also the skin , kidneys , and other tissues , potentially leading to pain , fatigue , and physical impairments .
The causes of both conditions and the reason they tend to afflict women are still unknown , but immune system differences among the sexes are believed to play an important role . One of these is that female immune cells are usually able to mount a stronger response against pathogens compared to those of males , suggesting that an immune dysfunction would be similarly more potent in women , explained Dr Margaret Ma , a rheumatologist at the Singapore National University Hospital .
Hormones , the substances that regulate key biological processes like sexual development and blood sugar levels , are also potential drivers of immune disorders , whose incidence also varies based on age .
RA is a good case in point as it ’ s much more common among women than men under the age of 50 but this difference lessens as age increases . A reason for this could involve the menopause as the level of sex hormones changes , said Dr Ma . She stressed , however , that researchers were still looking into how sex hormones could affect autoimmune diseases like RA .
In a similar vein , most lupus cases occur after puberty , when individuals reach sexual maturity due to hormonal activity , which could mean that either female hormones contribute to the disease or male ones offer protection against it by partially suppressing the immune system , explained Dr Michelle Petri , director of the Lupus Center at Johns Hopkins , to Global Health Asia-Pacific .
The former hypothesis is borne out by the observation that oral contraceptives — synthetic versions of the female hormones oestrogen and progestin many women take to prevent pregnancy — are a predisposing factor for later lupus , potentially putting women of childbearing age at higher risk than
“ Lupus is so complicated that immunologists are still trying to figure out the causation , which includes genetic predisposition and early childhood exposure to common infections like Epstein-Barr virus , mercury , and pesticides .”
GlobalHealthAsiaPacific . com MAY 2022
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