Saturday, May 8, 2010

Autoimmunity and Women

Autoimmunity and Women
Even though there is some universally accepted knowledge about autoimmunity, its victims -- mainly women -- have suffered from a lack of focus and a scattered research approach. For example, autoimmunity is known to have a genetic component and tends to cluster in families as different autoimmune diseases. In some families, a mother may have lupus; her son, juvenile diabetes; her sister, antiphospholipid syndrome; and her grandmother, rheumatoid arthritis.

Getting a proper diagnosis is sometimes as difficult as living with the disease itself. Victims face problems not only because physicians often don't think of autoimmunity, but also because of who we are, namely, a women in the childbearing years. As a rule, this is a time in a woman's life when we look healthy, though looks can be deceiving. Which is why we often say…just because I don’t look sick doesn’t mean I’m not…while secretly thinking to ourselves…’you idiot’ while V-8 slapping them in the forehead.  Often, women who suffer from autoimmune diseases are not taken seriously when we first begin consulting our doctors. A woman's symptoms are likely to be vague in the beginning, with a tendency to come and go, and hard to describe accurately to our physician. 

In a typical scenario, we are often shunted from specialist to specialist and forced to undergo a battery of tests and procedures before a correct diagnosis is made, which can sometimes take years.  A great many of us with autoimmune diseases have been labeled chronic complainers or hypochondriacs in the earliest stages of our illness. This can be devastating to a young woman.  We may even begin to question our own sanity as we try desperately to find out what is wrong. Tragically, many of us suffer significant damage to our organs in the meantime and end up carrying this health burden with us for the rest of our lives because of the delay in diagnosis.

If the public, particularly women, and medical practitioners were more aware of the genetic predisposition to develop autoimmune disease, clearly there would be more emphasis on taking a medical history regarding autoimmune diseases within the family when presented by a patient with confusing symptoms. Earlier screening of these diseases could not only prevent significant and lifelong health problems but also actually prevent some autoimmune diseases.

An example is antiphospholipid antibody syndrome (APS)…the disease which killed my paternal grandmother and triggered my mother’s heart attacks. In this disease, the patient produces antibodies against phospholipids -- fat found in every cell wall. The major consequence of APS is blood clotting, which can cause stroke, miscarriages, migraine headaches, and clotting disorders. APS occurs by itself or may accompany many of the autoimmune diseases. It is a significant cause of strokes in women under the age of 35 as well as recurrent miscarriage. Yet it would be unusual for a patient with an autoimmune disease other than lupus to be checked for it. APS has also been indicated as a causative factor in cardiovascular disease in women. The fortunate fact is that APS can be treated simply with either a baby aspirin or other blood thinners which are given to prevent strokes, miscarriage, and blood clots. The sad fact, however, is that many patients who could be treated in such a manner are never identified until after they have had a stroke or miscarriage.

What's New on the Research Horizon?
There is a significant need for more collaboration and cross fertilization of basic autoimmune research. Research that focuses on the etiology of all autoimmune related diseases rather than a singular autoimmune disease will bring us to the root causes of these diseases rather than the superficial level of treating the symptoms after the disease has had its destructive effects. At the present time, there is very little focus on basic autoimmune research, even though one in five Americans has an autoimmune related disease.

On the positive side, while basic research has lagged, there have been some exciting breakthroughs in research that is focused on new treatments for autoimmune diseases. In fact, several therapeutic approaches are in Phase III clinical trials. For the most part, treatment therapies for autoimmune diseases have remained fairly constant for the past two decades with few changes. New treatment modalities, such as TNF inhibitors, are showing promise for several of the autoimmune diseases that fall into different clinical specialties, such as rheumatoid arthritis, a rheumatic autoimmune disease; Crohn's disease, a gastrointestinal autoimmune disease; and psoriasis, a dermatological autoimmune disease.

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