National Women’s Health Report P U B L I S H E D B Y T H E N A T I O N A L W O M E N ’ S H E A L T H R E S O U R C E C E N T E R
or 41-year-old Judy Pate, it started in June 2006 with nervousness, a
pounding heart and shaky legs that were so weak it was so hard to climb
Fthe stairs to her Boston apartment. A few weeks later, having missed
three days of work with what she thought was the flu, she finally received her
diagnosis: Graves’ disease, a form of hyperthyroidism, caused by an overpro-
5 Major Autoimmune
Catherine Thomas’s diagnosis came 22 years ago, the day she woke up and found she
Diseases in Women
couldn’t walk without help. With three daughters under the age of six to care for, she was
6 Ages & Stages:
terrified. But when she heard the diagnosis, she was more mystified than fearful—lupus,
Women & Thyroid Disease
Cindy Baglietto saw a podiatrist three times in the winter of 2006 before she finally got
7 Ask the Expert: Commonly Asked
the right diagnosis for the excruciating pain in her hands and feet, pain so severe it felt as
Questions & Answers
if every finger were broken: rheumatoid arthritis.
And Cindy Holzer, herself a health education and gym teacher, had to nearly lose her
vision before she finally figured out what was going on in her body and went to the doctor. 8 Lifestyle Corner: Autoimmune Diseases
While the four women have very different diseases, their conditions share one thing:
Demand a Low-Stress
They’re all autoimmune diseases, caused by an out-of-whack immune system.
More than 80 autoimmune diseases have been identified so far, making the category as
a whole the third most common major illness in the United States, affecting about one in31 Americans.1 And for reasons we still don’t understand, women are far more likely to
“It’s really shocking when you put all the numbers together,” says Caroline Whitacre,
PhD, professor in the department of molecular virology, immunology and medical genetics
Published six times a year bythe National Women’s Health
at Ohio State University in Columbus. She led a task force of autoimmune experts in 1998
that summarized what was currently known about sex differences in autoimmunity and
developed an agenda for future research.
While women overall are 2.3 times more likely than men to develop an autoimmune
disease, the sex disparities vary depending on the disease.1 For instance, women are fivetimes more likely to develop hypothyroidism, up to nine times more likely to develop
systemic lupus erythematosus (SLE), three to four times more likely to develop Graves’ disease, three times more likely to develop rheumatoid arthritis and scleroderma, and twiceas likely to develop multiple sclerosis. Plus, nine out of 10 people with Sjögren’s syndromeare women.1,3,4,5
AUTOIMMUNE DISEASES continued from page 1 PRESIDENT AND CEO Audrey Sheppard
trigger.6 In some instances, it seems, that
EXECUTIVE VICE PRESIDENT
trigger might be a virus, even a flu virus. Elizabeth Battaglino Cahill, RN
of estrogen and progesterone are high. EDITORIAL DIRECTOR
fight that virus, some genetic switch flips
Heidi Rosvold-Brenholtz DIRECTOR OF COMMUNICATIONS
after the virus is eradicated, the immune
Amber McCracken Debra L. Gordon
ducing beta cells, as in Type 1 diabetes,
NWHRC MEDICAL ADVISOR Pamela Peeke, MD, MPH EDITORIAL ADVISORS Caroline Whitacre, PhD
Professor, Department of Molecular Virology,
College of Medicine, Ohio State University
Lawrence Wood, MD
after giving birth may play a role in some
Systemic Lupus Erythematosus (SLE) Joan T. Merrill, MD
Medical Director, Lupus Foundation of America
do anything about it,” recalls Catherine
Head, Clinical Pharmacology Research Program
they can affect the cell’s behavior. In
Francine Kaufman, MD
lupus but not to worry. So she didn’t.
Scott Zashin, MD
“So it’s that very close relationship
Rheumatologist, Clinical Assistant Professor
University of Texas Southwestern Medical School
ease than the dermatological version.
mune diseases,” says Dr. Whitacre.
For subscription inquiries, address changes or payments,
Write: National Women’s Health Report,
157 Broad Street, Suite 315, Red Bank, NJ 07701
The National Women’s Health Report provides health
behind the actual diseases themselves.
information for women interested in making informed
decisions about their health. This information does not
suggest individual diagnosis or treatment. This publication
is not a substitute for medical attention. The publisher
blood vessels and brain. It’s a disease
cannot accept responsibility for application of the
information herein to individual medical conditions. The
National Women’s Health Resource Center does not
endorse or promote any medical therapy or device.
Opinions expressed by individuals consulted for this issue
do not necessarily reflect those of the Resource Center.
2006 NWHRC. All rights reserved. Reproduction of
material published in the National Women’s Health Report
is encouraged with written permission from NWHRC. Write
to address above or call toll-free number.
National Women’s Health Report September 2006
While hormones may help explain why women are more likely to develop these diseases than men, they aren’t
hasn’t had a flare in eight years. behind the actual diseases themselves. Rheumatoid Arthritis AUTOIMMUNE DISEASES continued from page 3 Resources American Autoimmune Related Diseases Association 1-800-598-4668 It takes more than a few rogue genes to develop an autoimmune disease, Lupus Foundation of America however; it may take an environmental trigger. American Diabetes Association
www.diabetes.orgProvides information on and support for
Offers resources on all types of arthritis. Sjögren’s Syndrome Foundation The Thyroid Foundation of America
Provides information, support andphysician referrals. The National Multiple Sclerosis Society Type 1 Diabetes Autoimmune Disease Description Common Symptoms Primary Treatment Ulcerative colitis3
Blood, diarrhea, pain, urgent Anti-inflammatory drugs and corticosteroids.
bowel movements, jointpains and skin lesions. Multiple sclerosis11
Immune-modifying drugs such as Avonex, Rebif, Betaseron
and Copaxone, and immunosuppressant medications such
eye pain, tremor, lack ofcoordination. Myasthenia gravis12
Anticholinesterase agents such as Mestinon (pyridostig-
fatigue, including weakness mine), corticosteroids and immune system suppressors such
as Imuran (azathioprine) and intravenous immunoglobulins.
Surgical options include removing the thymus gland to
suppress the immune system or removing abnormal antibodies from blood plasma. Psoriasis
Phototherapy, topical medications including Drithocreme
(anthralin), Dovonex (calcipotriene), salicylic acid, coal
white scales that form on the tar, Tazorac (tazarotene) and topical corticosteroids.
Biologics and systemic drugs including Amevive
(alefacept), Raptiva (efalizumab), Enbrel (etanercept)
Swelling and puffiness of the D-penicillamine to decrease skin thickening; other
fingers and hands, skin ulcers, symptoms treated as needed. Sjögren’s syndrome3
Over-the-counter eye and mouth moisteners. The
prescriptions Lacriserts (hydroxypropyl cellulose) for dry
eyes and Salagen (pilocarpine hydrochloride) and Evoxac
(cevimeline) for dry mouth. Anti-inflammatory drugs,
smells, thirst, tongue ulcers steroids and immune suppressants are also used.15and severe dental caries. Vitiligo16
Phototherapy, often in combination with topical treat-
ments like psoralen melagenine (an extract from human
placenta), psoralen and corticosteroids or newer biologics
such as Elidel (pimecrolimus) and Prograf (tacrolimus).
*More than 80 autoimmune diseases affect women. Diseases described above are some of the more common ones.
STAGES Women & Thyroid Disease
You’d think Judy Pate, 41, would have recognizedthe symptoms of hyperthyroidism, or Graves’disease, when she developed them last winter.
After all, she’s been the administrative director
thyroidism,” he says, which canincrease the risk of miscarriage,
at the Thyroid Foundation of America in Boston
Btion can be, it took months body’s metabolism speeds up. diseases have their thyroid hor-
By the Numbers
You’d think testing for thyroid hormone levels would be
relatively simple. It’s not. You have two types of thyroid
hormone: T4, or thyroxine, and T3, or triiodothyronine. Most
screening tests measure T4, which will usually be low if youhave hypothyroidism and high if you have hyperthyroidism.
But since 99 percent of T4 is bound to carrier proteins that
carry the thyroid hormone around in your body, levels
constantly change. Thus, the most sensitive test for thyroid
function is TSH, which measures a hormone released by your
pituitary gland that, in turn, tells your thyroid to release
thyroid hormone. Hyperthyroidism is usually diagnosed
when TSH levels are below 0.4 mU/L, or milliunits per liter;hypothyroidism is usually diagnosed when levels are above
Commonly Asked Questions about Autoimmune Diseases
I’ve just been diagnosed with lupus, and my
Why are corticosteroids so often prescribed for autoim-
family practitioner is certain she can remain as
mune diseases, and what are
my primary doctor. Do I need to see a specialist?
their risks? Are there any alternative remedies you recommend for lupus or rheumatoid arthritis?
are looking into using concen-trated amounts of specific foods
Rheumatologist, Clinical Assistant ProfessorMedical Director, Lupus Foundation of AmericaUniversity of Texas Southwestern Medical SchoolHead, Clinical Pharmacology Research ProgramOklahoma Medical Research FoundationAuthor of Arthritis without Pain:
can interact with medicationsyou may be taking. References 1 Jacobson DL, Gange SJ, Rose NR, Graham NM. 7 Lupus Foundation of America. There’s more http://www.psoriasis.org/about/faq/. 21 Peralta-Ramirez MI, Jimenez-Alonso J,Epidemiology and estimated population bur-to lupus than you know. Available at:14 National Psoriasis Foundation. PsoriasisGodoy-Garcia JF, Perez-Garcia M; Group Lupusden of selected autoimmune diseases in thetreatment. Available at: http://www.psoria-Virgen de las Nieves. The effects of dailyUnited States. Clin Immunol Immunopathol.8 National Institute of Health. Handout onstress and stressful life events on the clinicalHealth: Systemic Lupus Erythematosus. Avail-15 The Sjögren’s Syndrome Foundation. Treatmentsymptomatology of patients with lupus ery-2 Whitacre CC, Reingold SC, O’Looney PA. able at: http://www.niams.nih.gov/hi/top-for Sjögren’s. Available at: http://www.sjogrens.org/A gender gap in autoimmunity. Science. 1999ics/lupus/slehandout/index.htm#Lupus_1. 9 O’Dell JR. Therapeutic strategies for rheumatoid16 Huggins RH, Schwartz RA, Janniger CK. Vitiligo.22 Li LC. What else can I do but take drugs? The3 American Association of Clinical Endocrinolo-arthritis. N Engl J Med. 2004 Jun 17;350(25):Acta Dermatovenerol Alp Panonica Adriat.future of research in nonpharmacologicalgists. Thyroid Fact Sheet. Available at:2005 Dec;14(4):137–42, 144–5. Review.treatment in early inflammatory arthritis. Jhttp://www.medem.com/medlb/article_detai10 Nayar M, Rhodes JM. Management of inflam-17 Ai J, Leonhardt JM, Heymann WR. AutoimmuneRheumatol Suppl. 2005 Jan;72:21–4. Review.llb.cfm?article_ID=ZZZNIEIUKIE&sub_cat=0.matory bowel disease. Postgrad Med J. 2004thyroid diseases: etiology, pathogenesis, and23 Rietberg MB, Brooks D, Uitdehaag BM, Kwakkel4 American Autoimmune Related Diseases dermatologic manifestations. J Am Acad Der-G. Exercise therapy for multiple sclerosis.Association. Autoimmune diseases in women:11 National MS Society. Disease managementmatol. 2003 May;48(5):641–59; quiz 660–2.Cochrane Database Syst Rev. 2005 Jan 25;(1):The facts. Available at: www.aarda.org/women.php.consensus statement. Available at:18 Tews MC, Shah SM, Gossain VV. Hypothyroidism:5 Wood LC, Cooper DS. Ridgway EC. Your Thyroid:http://www.nationalmssociety.org/Source-mimicker of common complaints. Emerg Med24 Sigurdardottir AK. Self-care in diabetes:A Home Reference, 4th edition. BallantineClin North Am. 2005 Aug;23(3): 649–67, vii.model of factors affecting self-care. J Clin12 Myasthenia Gravis Foundation of America.19 Ladenson PW, Singer PA, Ain KH et al. AmericanNurs. 2005 Mar;14(3):301–14. Review.6 Reeves GE. Update on the immunology, Facts about Autoimmune myasthenia gravis.Thyroid Association guidelines for detection of25 Schoofs N. Seeing the glass half full: livingdiagnosis and management of systemic lupusAvailable at: http://www.myasthenia.org/thyroid dysfunction. Arch Intern Medwith Sjogren’s Syndrome. J Prof Nurs. 200113 National Psoriasis Foundation. 20 The American Thyroid Association, ATAHypothyroidism Booklet. www.thyroid.org. 2003.Autoimmune Diseases Demand a Low-Stress Lifestyle
Whenever I see a woman with an autoimmunedisease in my office, one of the first things Iask her is how she’s handling the stress in herlife, and if she’s finding time to rest.
● Learn at least one technique to reduce stress hormones in
● Participate in your care. If your body. Notice I didn’t say
● Find a support system. This
● Take a walk. It doesn’t have
● Understand you are on a journey without end. Living
● Learn to slow down.
● Take an hour a day to rest.
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