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(for Diabetes, see Diabetes Fact Sheet)
  • According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases at NIH, autoimmunity plays a role in more than 80 different diseases. These include: type 1 diabetes, multiple sclerosis, systemic lupus erythematosus (lupus), rheumatoid arthritis, scleroderma, Grave’s disease, and Sjogren’s syndrome.

  • Autoimmune diseases are the third most common major illness in the United States. The most common autoimmune diseases affect more than 8.5 million (or 1 in 31) Americans.1 As many as 50 million Americans are believed to suffer from some type of autoimmune disease, according to the American Autoimmune Related Diseases Association.

  • Autoimmune diseases are the eighth leading cause of death for women aged 15-64.2

Women’s Risk for Autoimmune Disease

  • Women are 2.7 times more likely than men to acquire an autoimmune disease.1

  • Women have enhanced immune systems compared to men, which increases women’s resistance to many types of infection but also makes them more susceptible to autoimmune diseases.3

  • Men appear to have higher levels of natural killer cell activity than women. This activity is associated with reduced levels of autoimmune disease.4

  • The plasma activity level of phospholipase A2, a key enzyme in causing chronic inflammatory diseases, is significantly higher in Caucasian and Asian Indian women than their male counterparts.5

  • A molecule involved in reducing the inflammatory response, Interleukin-1-receptor-II, is present in higher concentration in blood fractions from men than from women.6

  • The most striking sex differences are observed in Sjogren’s syndrome, lupus, autoimmune thyroid disease (Hashimoto’s thyroiditis and well as Graves’ disease), and scleroderma, which represent a spectrum of diseases in which the patient population is greater than 80 percent women. 7

  • In rheumatoid arthritis (RA), multiple sclerosis (MS), and myasthenia gravis the sex distribution is 60-75 percent women.7

Lupus

  • Systemic lupus erythematosus (lupus) affects nine times as many women as men,1 and accounts for 14.5 percent of all deaths from arthritis (lupus and arthritis often occur together). 8

  • Lupus primarily affects women of childbearing age. It has been suggested that sex hormones affect the course of the disease, because lupus typically decreases in intensity in postmenopausal women. In support of this idea, it has been found that, in women with lupus, the expression of calcineurin, a molecule that starts a signal for increased inflammatory response, is induced by estrogen, while in healthy women calcineurin levels remain unchanged by the effects of estrogen.9

  • African-American women are three times as likely to acquire lupus as Caucasian women.10

  • Among women aged 18-44, those with lupus are more than twice as likely as unaffected women to suffer a heart attack.11

Multiple Sclerosis

  • Twice as many women as men are afflicted with multiple sclerosis (MS).12 This may be caused by the protective role of testosterone in young men and the protective role of estriol in pregnant women.13

  • The number of MS flares is reduced during pregnancy (a time of high estrogen and progesterone levels), especially in the second and third trimesters, however the risk of a flare in the postpartum period is greatly increased.16

  • In women with MS who notice differing symptom levels correlating with their menstrual cycles, symptoms worsen in the days preceding menses, when estrogen levels are low.14, 15

  • Interferon-beta, a widely used drug to treat MS, is more likely to induce thyroid dysfunction in women than men.17

References
1. Jacobson DL, Gange SJ, Rose NR, Graham NM. Epidemiology and estimated population burden of selected autoimmune diseases in the United States. Clin Immunol Immunopathol. 1997;84(3):223-243.
2. 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.
3. Cannon JG, St Pierre BA. Gender differences in host defense mechanisms. J Psychiatr Res. 1997;31(1):99-113..
4. Yovel G, Sirota P, Mazeh D, Shakhar G, Rosenne E, Ben-Eliyahu S. Higher natural killer cell activity in schizophrenic patients: the impact of serum factors, medication, and smoking. Brain Behav Immun. 2000;14(3):153-169.
5. Kuslys T, Vishwanath BS, Frey FJ, Frey BM. Differences in phospholipase A2 activity between males and females and Asian Indians and Caucasians. Eur J Clin Invest. 1996;26(4):310-315.
6. Daun JM, Ball RW, Cannon JG. Glucocorticoid sensitivity of interleukin-1 agonist and antagonist secretion: the effects of age and gender. Am J Physiol Regul Integr Comp Physiol. 2000;278(4):R855-862.
7. Whitacre, Nature Immun 2001 Sept;2 (9):777-80.
8. From the Centers for Disease Control and Prevention. Trends in deaths from systemic lupus erythematosus—United States, 1979-1998. Jama. 2002;287(20):2649-2650.
9. Rider V, Foster RT, Evans M, Suenaga R, Abdou NI. Gender differences in autoimmune diseases: estrogen increases calcineurin expression in systemic lupus erythematosus. Clin Immunol Immunopathol. 1998;89(2):171-180.
10. NIAMS. The Many Shades of Lupus. National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) Information Clearinghouse, National Institutes of Health (NIH). August, 2001. Available at: http://www.niams.nih.gov/hi/topics/lupus/shades/index.htm#5.
11. Ward MM. Premature morbidity from cardiovascular and cerebrovascular diseases in women with systemic lupus erythematosus. Arthritis Rheum. 1999;42(2):338-346.
12. Wizemann TM, Pardue M-L, Eds. Exploring the Biological Contributions to Human Health: Does Sex Matter? Washington, DC: Board on Health Sciences Policy, Institute of Medicine; April 25 2001.
13. Voskuhl, Curr Neurol Neurosci Rep 2002 May;2(3):277-86.
14. Zorgdrager A, De Keyser J. Menstrually related worsening of symptoms in multiple sclerosis. J Neurol Sci. 1997;149(1):95-97.
15. Smith R, Studd JW. A pilot study of the effect upon multiple sclerosis of the menopause, hormone replacement therapy and the menstrual cycle. J R Soc Med. 1992;85(10):612-613.
16. The Multiple Sclerosis Information Sourcebook. New York, NY: The Information Resource Center and Library of the National Multiple Sclerosis Society; 2001.
17. Monzani F, Caraccio N, Meucci G, et al. Effect of 1-year treatment with interferon-beta1b on thyroid function and autoimmunity in patients with multiple sclerosis. Eur J Endocrinol. 1999;141(4):325-331.

Last updated: May 4, 2005