Autoimmune Diseases 83

Autoimmune Diseases

If you have an autoimmune (aw-toh-ih-MYOON) disease, your 

experience may have been frustrating and confusing. It can be 

hard to describe the often debilitating symptoms many people 

endure. And the medical community is still learning about these 

diseases, which affect mostly women. To date, there are no cures.

The good news is that there are treatments available to manage 

tough symptoms and you can feel better. At the same time, 

experts are working toward better treatments and perhaps even a 

way to prevent these diseases someday.

What are autoimmune diseases?

The immune system is a complex network of special cells and organs that 

defends the body from “foreign” invaders. These invaders can be germs, viruses, 

and other foreign things called antigens 

(AN-tih-juhnz). 

At the core of the immune system is the 

ability to distinguish between self and 

nonself: what’s you and what’s foreign. 

A flaw can make the body unable to tell 

the difference between self and nonself. 

When this happens, the body makes 

autoantibodies (AW-toh-AN-teye-bahdeez) that attack normal cells by mistake. 

At the same time, special cells called 

regulatory T cells fail to do their job of 

keeping the immune system in line. The 

result is a misguided attack on your own 

body. This causes the damage we know as 

an autoimmune disease.

Body Parts That Can Be Affected 

by Autoimmune Diseases

Trachea

Blood and 

Blood Vessels

Others:

Glands

Muscles

Nerves

Brain

Eyes

Mouth

Spinal Cord

Thyroid

Lung

Kidney

Stomach

Pancreas

Large Intestine

Small Intestine

Bladder

Vagina

Heart

Skin

Esophagus

Liver

Joints

Ovary

Uterus

Cervix
84 The Healthy Woman: A Complete Guide for All Ages

The more than 80 different autoimmune 

diseases are each defined by the kind of 

damage involved and the body part(s) 

affected. The blood, skin, eyes, nerves, 

and heart are just some of the body parts 

that can be involved.

Who is at risk of getting 

autoimmune diseases?

Individually, autoimmune diseases are 

rare. Together, they are a leading cause 

of disability and death. The number of 

people with autoimmune diseases is 

growing, but it is unclear why. It is also 

unclear why certain people are at greater 

risk of getting these diseases. To learn 

more, experts are studying patients to see 

what they may have in common.

Women of childbearing age. Of the 

more than 23.5 million people with 

autoimmune diseases, most are women. 

As a group, these diseases are a leading 

cause of death among young and middle-aged women. Often, they strike during childbearing years when women are 

likely juggling multiple roles as mothers, 

caregivers, employees, friends, community members, and much more. Dealing 

with an autoimmune disease can be a 

trying experience on top of an already 

busy life.

Hormones are thought to play an important role because some autoimmune 

diseases “act” differently during pregnancy, menstruation, and menopause. 

Hormone changes at these times can 

cause symptoms to either get worse or 

better, depending on the disease. For 

instance, rheumatoid arthritis (ROOmuh-toid ar-THREYE-tuhss) improves 

during pregnancy, whereas systemic 

lupus erythematosus (LOO-puhss urih-thee-muh-TOH-suhss), known as 

lupus, worsens. Pregnancy is also known 

to trigger thyroiditis (theye-roi-DEYEtiss) after the baby is born. Yet the question about whether female hormones 

cause these diseases is yet to be answered.

People with a family history. Heredity 

plays an important role. Some diseases 

run in families, such as lupus, multiple 

sclerosis (MUHL-tip-uhl sklur-OHsuhss), and vitiligo (vit-uhl-EYE-goh). 

It is also common for different members 

of one family to have different types of 

autoimmune diseases. 

For instance:

l	 A woman may have rheumatoid 

arthritis.

l	 Her mother may have Hashimoto’s 

(hah-shee-MOH-tohz) disease.

l	 Her grandmother may have type 1 

diabetes.
Autoimmune Diseases 85

To understand this family link, experts 

need to identify the genes that make 

people more likely to get certain autoimmune diseases. The good news is that 

some progress has been made, often by 

studying families with multiple members 

who have autoimmune diseases. In the 

past few years, more has been learned 

about the genetic basis of rheumatoid 

arthritis, vitiligo, lupus, psoriasis (suhREYE-uh-suhss), and others. 

People who are around certain things 

in the environment. Many things may 

cause or intensify certain diseases:

l	 The ultraviolet rays in sunlight can 

make the symptoms of lupus worse.

l	 Being around industrial solvents may 

increase the risk of developing scleroderma (sklair-oh-DUR-muh) or lupus.

l	 Dietary iodine may be responsible for 

an increase in the number of people 

who have thyroiditis.

l	 Research has linked infections caused 

by a variety of bacteria and viruses that 

have been linked to many immune diseases, including multiple sclerosis, type 

1 diabetes, rheumatoid arthritis, lupus, 

and others. Sex hormones may further 

boost the immune system’s overreaction to infections in women who are 

already at risk for these diseases. This 

could help explain why these diseases 

are more common in women.

Although these links have been seen, 

experts don’t yet know if avoiding infections and sunlight can stop an autoimmune disease from happening. And other possible triggers, such as some metals, 

need to be studied more.

People with certain ethnic backgrounds. Experts are not yet sure why, 

but some ethnic groups seem to be at 

greater risk of certain diseases.

l	 Type 1 diabetes is more common in 

white people.

l	 Lupus is three times more common 

in African American women. Lupus 

is also more common in Hispanic, 

Asian, and American Indian women. 

The disease is more severe for African 

American and Hispanic people, who 

also develop symptoms at a younger 

age.

Common Links Among People 

With Autoimmune Diseases

• women of childbearing age

• people with a family history

• people who are around certain 

things in the environment

• people of certain ethnic backgrounds

For more information on genes and 

genetic counseling, see pages 408 and 

409 of the Appendix. 
86 The Healthy Woman: A Complete Guide for All Ages

l	 Choctaw Native Americans have 

higher rates of scleroderma. African 

Americans, Hispanics, and Native 

Americans may also have more severe 

forms of the disease.

These differences may be due to a genetic 

link. Exposure to similar things in the 

environment may also explain why certain communities are affected more than 

others.

Genes + Environment

Inheriting certain genes can raise your 

risk of getting an autoimmune disease, but it may be an event or exposure to something outside of your body 

that actually triggers it.

The role of environmental exposures in 

the absence of a genetic link is still unclear. In the case of heart disease, we 

know you can lower your risk by eating 

less saturated fat, exercising, and taking other heart-healthy steps. We don’t 

yet know if the things you do—or don’t 

do—can raise or lower your risk of autoimmune diseases on their own.

Types of autoimmune diseases

Some autoimmune diseases are life 

threatening. Nearly all of these diseases 

are debilitating and require lifelong medical care. Although each is unique, these 

diseases in general have much in common. Many of them share hallmark 

symptoms, such as fatigue, dizziness, and 

low-grade fever. Many also go through 

remissions, when symptoms go away, and 

“active” disease stages, when symptoms 

flare.

The autoimmune diseases discussed in 

the following chart are more common in 

women than in men.

Types of Autoimmune Diseases

Disease Body part(s) Who gets it? Symptoms Tests to find out 

involved if you have it 

(See page 91 for a 

blood test glossary.)

Antiphospholipid (an- Clots can de- More common in • Blood clots in veins or • Blood test

teye-FOSS-foh-lip-ihd)

antibody syndrome

(aPL)

A disease that causes 

problems in the inner 

lining of blood vessels 

resulting in blood clots 

velop in the 

brain, the veins 

of the legs and 

lungs, or in 

the placenta 

of pregnant 

women.

women arteries

• Multiple miscarriages

• Lacy, net-like red rash 

on the wrists and 

knees

• The disease is 

suspected if you 

have a history 

of blood clots or 

multiple miscarriages.

in arteries or veins.

Also called sticky 

blood syndrome
Autoimmune Diseases 87

Types of Autoimmune Diseases

Disease Body part(s) 

involved

Who gets it? Symptoms Tests to find out 

if you have it 

(See page 91 for a 

blood test glossary.)

Graves’ disease

A disease that causes 

the thyroid gland to 

make too much thyroid hormone. 

Also called diffuse 

thyrotoxic goiter or 

overactive thyroid

Thyroid gland Women older 

than 20, 

although it may 

occur at any age 

and may also 

affect men 

• Insomnia (not being 

able to sleep)

• Irritability

• Weight loss

• Heat sensitivity

• Sweating

• Fine brittle hair

Blood test for 

thyroid-stimulating 

hormone (TSH)

• Muscle weakness

• Light menstrual 

periods

• Bulging eyes

• Shaky hands

You may have no symptoms.

Hashimoto’s 

thyroiditis

Inflammation of the 

thyroid gland that 

stops it from making enough thyroid 

hormones. It is the 

most common thyroid 

disease in the United 

States.

Thyroid gland • 

• 

Middle-aged 

women

People with a 

family history

• 

• 

• 

• 

• 

• 

• 

Fatigue

Weakness

Weight gain

Sensitivity to cold

Muscle aches and stiff 

joints

Facial swelling

Constipation

Blood test for 

thyroid-stimulating 

hormone (TSH)

Also called autoimmune thyroiditis, 

chronic thyroiditis, or 

underactive thyroid

Multiple sclerosis

A disease in which 

the immune system 

attacks the protective coating, called 

myelin, around the 

nerves. The damage 

affects the brain and 

spinal cord, causing 

muscle weakness, 

loss of coordination, and vision and 

speech problems.

Central nervous system 

(brain and spinal cord)

• 

• 

More common 

in women 

than men

Most common 

between ages 

20 and 40, 

but can strike 

at any age

• 

• 

• 

• 

•

Weakness and trouble 

with coordination, balance, seeing, speaking, and walking

Paralysis

Tremors

Numbness and a 

tingling feeling in the 

arms, legs, hands, and 

feet

Symptoms vary because 

the location and extent 

of each attack vary.

• 

• 

• 

• 

An exam of your 

body

An exam of your 

brain, spinal 

cord, and nerves 

(a neurological 

exam)

X-ray tests 

Other tests on 

the brain and 

spinal cord fluid
88 The Healthy Woman: A Complete Guide for All Ages

Types of Autoimmune Diseases

Disease Body part(s) 

involved

Who gets it? Symptoms Tests to find out 

if you have it

(See page 91 for a 

blood test glossary.)

Myasthenia gravis 

(MG) (meye-uhssTHEEN-ee-uh GRAVuhss)

A disease in which 

the immune system 

attacks the nerves 

and muscles, causing weakness and 

problems with seeing, 

chewing, walking, and 

talking.

Muscles 

throughout the 

body and the 

thymus gland, 

which is in the 

chest

• Can affect 

people at any 

age

• Most common in young 

women and 

older men

• Double vision, trouble 

keeping a steady gaze, 

and drooping eyelids

• Trouble swallowing, 

with frequent gagging 

or choking (called a 

crisis)

• Weakness or 

paralysis

• Muscles that work better after rest

• Drooping head

• Trouble climbing stairs 

or lifting things

• Trouble talking

• Physical and neurologic exams

• Blood test 

• Injection of a 

drug that briefly 

improves muscle 

strength in people with MG

• Nerve stimulation tests 

that can show 

impaired nerveto-muscle communication in 

people with MG

• Tests to measure breathing 

strength

Rheumatoid 

arthritis

A disease in which 

the immune system 

attacks the lining of 

the joints throughout 

the body.

Joints, lungs, 

heart, and 

other organs

Usually occurs in 

people between 

ages 25 and 55

• Joint pain, stiffness, 

swelling, and malformation

• Reduced movement 

and function

May have:

• Fatigue

• Fever

• Weight loss

• Eye inflammation

• Anemia (uh-NEE-meeuh)

• An exam of your 

body

• X-rays of the 

joints

• Blood test to detect anemia, the 

antibody rheumatoid factor (RF), 

and citrulline 

antibodies (CCP).

(Some people 

with RF never 

get this disease. 

Others who have 

this disease do 

not have this 

antibody.)

• Test of the fluid 

in the joints may 

be needed
Autoimmune Diseases 89

Types of Autoimmune Diseases

Disease Body part(s) 

involved

Who gets it? Symptoms Tests to find out 

if you have it 

(See page 91 for a 

blood test glossary.)

Scleroderma Skin and possi- • People 30 to • Fingers and toes • Exam of the skin 

A disease causing 

abnormal growth of 

connective tissue in 

the skin and blood 

vessels. In more 

severe forms, this 

bly the kidneys, 

lungs, heart, 

and gastrointestinal tract

50 years old, 

more often 

women 

• People around 

silica dust and 

polyvinyl chlothat turn white, red, 

or blue in response 

to heat and cold 

(called Raynaud 

phenomenon)

• Pain, stiffness, and 

for tightness, 

thickening, and 

hardening

• Blood tests

• Urine test

tissue can build up ride may be at swelling of fingers and • Chest x-ray

internally, leading in risk joints • Lung function 

some cases to organ 

failure. • Thickening of the skin

• Skin that looks shiny 

on the hands and 

forearm

• Tight and mask-like 

facial skin

• Sores on the fingers or 

toes

• Trouble swallowing

• Weight loss

• Diarrhea or 

constipation

• Shortness of breath

test

• Skin biopsy

Sjögren’s syndrome Mucous mem- Most common in • Dry eyes or eyes that • Blood tests 

(SHOH-grins)

A disease in which 

the immune system 

targets the glands 

that make moisture, 

such as tears and 

branes, such 

as the eyes 

and mouth

women 40 to 50 

years old • 

• 

• 

itch

Dryness of the mouth, 

which can cause sores

Trouble swallowing

Loss of sense of taste

• 

• 

Biopsy of the 

salivary gland

A test to see 

if you make 

enough tears

saliva, leading to 

dryness of the eyes, • Severe dental 

cavities

• An eye test using 

a special dye

mouth, and other 

body tissues. • 

• 

• 

• 

• 

Hoarseness

Fatigue

Joint swelling or pain

Swollen glands

Cloudy eyes
90 The Healthy Woman: A Complete Guide for All Ages

Types of Autoimmune Diseases

Disease Body part(s) 

involved

Who gets it? Symptoms Tests to find out 

if you have it 

(See page 91 for a 

blood test glossary.)

Systemic lupus Skin, joints, Mostly young • Fever • An exam of your 

erythematosus

A disease that can 

damage the joints, 

skin, kidneys, and 

lungs, kidneys, 

brain, lungs, 

and heart

women • Weight loss

• Hair loss

• Mouth ulcers (sores)

body

• Urine test

• Blood test

other parts of the • Extreme fatigue

body. • “Butterfly” rash across 

Also called SLE or the nose and cheeks

lupus • Rashes on other parts 

of the body

• Painful or swollen 

joints and muscle pain

• Sensitivity to the sun

Other autoimmune diseases include 

Addison’s disease, vitiligo, type 1 diabetes, and celiac (SEE-lee-ak) disease. You 

are more likely to get a second autoimmune disease if you already have one. For 

instance, people with Addison’s disease 

often have type 1 diabetes.

Getting diagnosed

You may not have a clear pattern of 

symptoms at first. You may not have the 

same pain or problem every time. Some 

diseases may also not have any symptoms 

until they have advanced. And most of 

Digestive Diseases

There are some autoimmune diseases 

that affect the digestive system that 

are more common in women. For 

more information on Crohn’s disease, 

autoimmune hepatitis, primary biliary 

cirrhosis (BIL-ee-air-ee sur-ROH-suhss), 

and ulcerative colitis, see the Digestive 

Health chapter on page 265.

these diseases lack the diagnostic “checklist” that helps doctors identify them early. Many tests and exams may be needed 

to make a diagnosis.

The following steps will help your doctor 

diagnose your disease:

l	 Medical history. The doctor will ask 

about your symptoms and how long 

you have had them. Your symptoms 

may not point to one disease. But they 

can be a starting point for your doctor. 

Tell your doctor if you have a family 

member with autoimmune disease. 

l	 Physical exam. Your doctor will check 

for signs such as swollen joints or 

lymph nodes, or skin that looks off 

color.

l	 Medical tests. No one test will show 

that you have an autoimmune disease. 

But doctors may find clues in a blood 

sample. (See page 91 for information 

on blood tests.)
Autoimmune Diseases 91

What type of blood tests may be done?

Antinuclear antibody or ANA (also known as fluorescent antinuclear antibody):

This test detects autoantibodies. The presence of ANA can be a marker or sign of several autoimmune diseases. ANA is most commonly seen in lupus.

Rheumatoid factor (RF):

This test detects and measures RF, an autoantibody that can mean you have rheumatoid arthritis, Sjögren’s syndrome, or other autoimmune diseases. Some people have 

RF without any disease.

C-reactive protein (CRP):

C-reactive protein is a substance made by the liver that can be found in the blood. A 

high level of this substance can mean there is inflammation in the body. This test can 

help diagnose inflammatory bowel disease, rheumatoid arthritis, lupus, and other 

diseases.

Erythrocyte sedimentation rate (ESR):

This test is used to measure inflammation. It can’t tell exactly where the inflammation 

is, so it is used along with other tests.

Citrulline antibody (CCP or anti-CCP):

This fairly new test detects citrulline antibodies, thought to be made by the immune 

system during inflammation. CCP can be useful in diagnosing rheumatoid arthritis early, especially in people who have symptoms but do not have RF (see RF test 

above).

Some people may be able to get a diagnosis quickly. For others, the process is 

much slower. Some people may be told 

they have something autoimmune related, but they are unable to get a precise 

label for their symptoms. Others find 

they can’t get a diagnosis at all and spend 

years searching for answers. Still others 

find it difficult to get a correct diagnosis. 

Sadly, many patients have been told that 

their symptoms were stress related or in 

their heads. The hope is that increased 

awareness and research efforts will improve this experience. In the meantime, 

there are steps you can take to help make 

things easier.

What you can do:

l	 Write down your family’s health history and share it with your doctor. 

Include all of the health problems your 

parents, siblings, grandparents, and 

cousins (if possible) have had.

l	 Write down all of the symptoms you 

have had and share the list with your 

doctor. Some symptoms may not seem 

related, but they may be after all. Put 

the symptoms that bother you the 

most at the top of your list.

l	 Seek out referrals to good doctors, 

starting with a specialist who deals 

with your most major symptom. 

Check with family members, friends, 
92 The Healthy Woman: A Complete Guide for All Ages

and health care professionals in your 

community for recommendations.

l	 Ask about your doctor’s experience 

with autoimmune diseases. The more 

patients he or she has treated, the 

better.

l	 Get a second, third, or fourth opinion 

if need be. If a doctor doesn’t take your 

symptoms seriously or refers you to a 

psychologist, find another doctor. You 

know how you are feeling and you are 

your own best advocate. Be sure to 

check on your insurance first to find 

out if it covers your visits.

Reproductive health

In the past, women with autoimmune 

diseases were told not to have children. 

This advice has changed with better 

treatments and understanding. Many 

health risks can be lowered by not getting pregnant during active stages of disease, when symptoms flare. Health risks 

can also be lowered by taking medicine 

that your doctor says is safe to take while 

pregnant. There may still be some risks 

for both the mother and baby, depending on the disease and how severe it is. 

But women with autoimmune diseases 

can safely have children. And, although 

symptoms may be worse during pregnancy for some women, others may find 

that their symptoms improve.

Before Pregnancy

It is important to talk to your doctor 

before trying to get pregnant. Along 

with your regular doctor(s), you may 

also need care from a maternal-fetalmedicine specialist. This type of doctor 

cares for women with health problems 

that may affect pregnancy.

How Autoimmune Diseases Affect Pregnancy

Disease What you should know about pregnancy

Antiphospholipid Pregnancy poses serious risks for both mother and baby. These risks include 

antibody syndrome stroke, blood clots, high blood pressure, and repeated miscarriage. For the baby, 

(aPL) there is a risk of stillbirth or fetal death, poor growth in the womb, and preterm 

birth. Pregnant women with aPL often need more frequent prenatal care visits.

It is not clear whether this disease gets worse or better during pregnancy.

Hashimoto’s thyroiditis Also called painless thyroiditis or hypothyroidism, some women get this disease 

while pregnant. It causes thyroid problems in women after the baby is born. 

These problems are often not permanent. Many times, women have postpartum 

depression at the same time.
Autoimmune Diseases 93

How Autoimmune Diseases Affect Pregnancy

Disease What you should know about pregnancy

Lupus Pregnant women with lupus must be closely watched to help prevent problems 

such as preterm birth and stillbirth. Treatment may be needed during pregnancy 

to control your disease. 

Symptoms tend to worsen during the second half of pregnancy and after the 

baby is born. Yet this will not make the outcome of the disease worse for you. 

A long period of remission before getting pregnant can lower your chances of a 

flare-up during pregnancy.

Rarely, babies born to women with lupus have neonatal lupus. This is not the 

same thing as lupus in adults. Babies with neonatal lupus can have a rash and, 

sometimes, a problem with their heartbeat. This problem is treatable. Babies 

with neonatal lupus have only a small chance of having lupus later in life.

Graves’ disease Also called hyperthyroidism, Graves’ disease can lead to preterm birth and low 

birth weight. Women may be at risk of high blood pressure during pregnancy.

Pregnancy does not appear to make the disease worse. Some women may 

have trouble getting pregnant. Pregnant women must have their thyroid levels 

watched throughout pregnancy. There are certain drugs that may cause birth 

defects and should not be used. 

Rheumatoid arthritis Symptoms generally improve during pregnancy, often allowing women to take 

less medicine. Symptoms usually flare up after the baby is born.

Scleroderma It may be best to wait to get pregnant for some time after the disease is diagnosed. It is important to talk to a doctor about timing. It is not clear if having this 

disease makes it harder for women to get pregnant, but some drugs can cause 

infertility.

Pregnant women will need to have their blood pressure watched carefully. Skin 

problems common to patients with scleroderma do not pose extra problems during pregnancy. The disease may be more active following delivery.

Multiple sclerosis (MS) Symptoms tend to improve during pregnancy. Pregnancy does not appear to 

make the disease worse. Women who don’t yet know they have MS may be 

more likely to start having symptoms during pregnancy. 

Having MS may make it hard for women to carry a pregnancy. Muscle weakness, 

coordination problems, and fatigue may make falls more likely. If in a wheelchair, women may have more urinary tract infections. Labor may also be more 

difficult, but there are things doctors can do to help. 

Myasthenia gravis (MG) Symptoms that lead to trouble breathing—a crisis—may happen during pregnancy. For some women, though, the disease may go into remission. 

There are some risks for pregnant women with MG, such as greater chances of 

preterm labor. It is also possible that the medicine used to treat MG may cause 

contractions. MG crises are also more likely to happen during labor. 

Pregnancy does not make the outcome of the disease worse for women.

Sjögren’s syndrome Many women first get this disease after childbearing age. Pregnancy-related 

problems tend to be tied to lupus or aPL, which patients with Sjögren’s often 

also have. 
94 The Healthy Woman: A Complete Guide for All Ages

Experts have long suspected the hormone estrogen to be a lupus trigger, 

leading them to warn against the use 

of birth control pills. Yet research has 

shown birth control pills to be safe in 

women with lupus.

Infertility

Some women with autoimmune diseases 

may have trouble getting pregnant. There 

are a few reasons behind this challenge:

l	 Type 1 diabetes, lupus, and hypothyroidism (Hashimoto’s thyroiditis) are 

linked to a higher risk of early menopause or premature ovarian failure 

(POF). Women with POF stop menstruating before age 40, lack estrogen, 

and are infertile. 

l	 Infertility is also caused by autoimmune oophoritis (oo-for-EYE-tuhss). 

With this disease, the body attacks 

its own cells that release reproductive 

hormones. This causes ovarian failure.

l	 Some treatments may cause infertility. Chemotherapy drugs, used to treat 

severe cases of lupus, can cause fertility 

to decline early.

Let your doctor know if you are having 

trouble getting pregnant. There are tests 

that can be done to see if your autoimmune disease is the root of the problem. 

Your doctor can also tell you if fertility 

treatments are an option for you.

Breastfeeding Safety

After pregnancy, it is important to talk 

to your doctor about the safety of your 

medications during breastfeeding.

Other health issues 

Fatigue can be a big problem for people 

who have autoimmune diseases. And 

some people may also have chronic fatigue syndrome (CFS) or fibromyalgia 

(feye-broh-meye-AL-juh) (FM) at the 

same time. Although these two conditions 

may share similar symptoms, they are not 

autoimmune diseases. CFS can cause you 

to have trouble concentrating, feel weak 

and very tired, and have muscle pain.

FM causes widespread body pain. People 

with FM also feel tired and have low 

energy. FM mainly occurs in women of 

childbearing age.

For more information on chronic fatigue syndrome and fibromyalgia, see 

the Pain chapter on page 351.

People with some autoimmune diseases 

can also be at greater risk of atherosclerosis (a-thuh-roh-skluh-ROH-suhss) 

and osteoporosis (OSS-tee-oh-puhROH-suhss). Atherosclerosis is the 

hardening and narrowing of the arteries. 

This problem can lead to heart disease. 

It is not clear why people with autoimmune diseases are at greater risk for this 

problem. People with osteoporosis have 
Autoimmune Diseases 95

low bone mass and weak bones. This disease leads to increased risk of fractures 

of the hip, spine, and wrist. Some treatments taken over time can cause osteoporosis. Routine care can help you spot 

and manage these health problems.

For more information on atherosclerosis, see the Heart Disease chapter on 

page 15. For more information on osteoporosis, see the Healthy Aging chapter on page 221.

Managing your disease

Having an autoimmune disease can 

cause debilitating symptoms, loss of 

organ function, reduced productivity at 

work, and high medical expenses. At the 

same time, it does not have to stop you 

from living your life. For many people, 

the disease does not define them. Rather, 

it is yet another challenge they can successfully manage. And there are many 

ways to cope with the different ways in 

which these diseases can affect your life.

l	 How you look and your self-esteem.

Depending on your disease, you may 

have discolored or damaged skin or 

hair loss. Your joints may look different. Such problems can’t always 

be prevented. But their effects can be 

reduced with treatment. Cosmetics, for 

example, can hide a skin rash. Surgery 

can correct a malformed joint.

l	 Caring for yourself. Painful joints or 

weak muscles can make it hard to do 

simple tasks. You may have trouble 

climbing stairs, making your bed, or 

brushing your hair. If doing daily tasks 

is hard, talk with a physical therapist. 

The therapist can teach you exercises 

to improve strength and function. 

An occupational therapist can show 

you new ways to do things or tools to 

make tasks easier.

l	 Family relationships. Family members may not understand why you 

don’t have energy to do things you 

used to do. They may even think you 

are just being lazy. But they may also 

be overly concerned and eager to 

help you. They may not let you do the 

things you can do. They may even give 

up their own interests to be with you. 

Share what you learn about your disease with your family. Involve them in 

counseling or a support group. It may 

help them better understand the disease and how they can help.

l	 Sexual relations. Damage to glands 

that produce moisture can lead to vaginal dryness. This makes intercourse 

painful. Pain, weakness, or stiff joints 

may make it hard for you to move the 

way you once did. You may be unsure 

of how you look. Or you may be afraid 

that your partner will no longer find 

you attractive. With communication, 

good medical care, and perhaps counseling, many of these issues can be 

overcome.
96 The Healthy Woman: A Complete Guide for All Ages

Dealing with doctors

If you have an autoimmune disease, you 

will likely need to see different health 

care professionals to treat varied health 

problems. For instance, patients with 

lupus may see a rheumatologist to treat 

the main disease, a nephrologist to treat 

kidney problems, and a dermatologist for 

skin problems. This can make getting care 

tough, especially if insurance coverage is 

lacking.

It can also be hard if you don’t have 

one doctor in charge of managing your 

overall care. Without this point person, 

it may be harder to deal with multiple 

specialists who don’t communicate well 

with one another. Ask if there is a way to 

designate one doctor to take the lead. It 

will also help to partner with your doctors early to learn how to deal with the 

long-term effects of your disease.

Treatments

How people fare varies with the specific 

disease. Most autoimmune diseases are 

chronic or ongoing, but many can be 

controlled with treatment. There are 

many types of treatment available, some 

of which treat more than one disease. 

Your treatment depends on the type of 

disease, how severe it is, and its symptoms. Treatments can do the following:

l	 Relieve symptoms. Relieving symptoms may be as simple as taking a 

drug for pain relief. It may also be as 

involved as having surgery.

l	 Preserve organ function. Treatment 

may be needed to prevent organ damage. Examples include drugs to control 

an inflamed kidney in people with 

lupus and insulin injections to regulate 

blood sugar in people with diabetes. 

These treatments don’t stop the disease. But they can save organ function. 

They can also help people live with 

disease complications.

l	 Target disease mechanisms. Some 

drugs may also be used to target how 

the disease works. In other words, 

they can suppress the immune system. 

These drugs include chemotherapy, at 

lower doses than used for treating cancer. A fairly new class of drugs called 

anti-TNF medications blocks inflammation in people with various forms 

of autoimmune arthritis and psoriasis. 

These drugs can lessen pain and improve quality of life for many people.
Autoimmune Diseases 97

Specialists Who Treat Autoimmune Diseases

A rheumatologist treats arthritis and other rheumatic diseases, such as scleroderma and lupus.

An endocrinologist treats gland and hormone problems, such as diabetes and thyroid disease.

A neurologist treats nerve problems, such as multiple sclerosis and myasthenia gravis.

A hematologist treats diseases that affect the 

blood, such as pernicious anemia and autoimmune hemolytic anemia.

A gastroenterologist treats problems with the digestive system, such as Crohn’s disease and ulcerative colitis.

A dermatologist treats problems of the skin, hair, and nails caused by diseases such 

as psoriasis, lupus, and alopecia areata (AL-uh-PEE-shuh AR-ee-AYT-uh).

A nephrologist treats kidney problems, such as inflamed kidneys caused by lupus.

A physical therapist helps patients with stiffness, weakness, and restricted body 

movement with proper levels of physical activity.

An occupational therapist helps patients improve their ability to perform daily activities, despite pain or other health problems. Special equipment and devices are used 

to help make things easier at work and at home.

A speech therapist helps people with speech problems from illnesses such as multiple sclerosis.

New treatments may be on the horizon. 

Experts are studying new drugs that 

prevent the immune system from attacking healthy body parts. These may prove 

helpful for treating a number of autoimmune diseases.

What you can do to feel better

Outside of treatments, there are things 

you can do to help yourself feel better. 

l	 Eat a healthy diet, including balanced 

meals. 

l	 Get regular physical activity. But be 

careful not to overdo it, and talk with 

your doctor first about physical activity 

plans. A gradual and gentle physical 

activity program often works well for 

people with long-lasting muscle and 

joint pain. Some types of yoga or tai 

chi exercises may also be helpful.

For more information on healthy eating, 

see the Nutrition chapter on page 317. 

For more information on physical activity, see the Fitness chapter on page 337.

l	 Try to lower your stress. Stress and 

anxiety can cause symptoms to flare up 

with some autoimmune diseases. So 

finding ways to relax can help man-
98 The Healthy Woman: A Complete Guide for All Ages

age a cycle of stress and flare-ups. Try 

using relaxation techniques, such as 

meditation. Other coping methods 

include:

• pacing yourself and your activities

• joining a support group

• talking with a professional counselor

Above all, be patient with yourself. Autoimmune diseases can be a big challenge, but not an impossible one. Care 

is better today than ever before, and 

continued improvement is likely. The extensive research taking place holds much 

promise for better ways to diagnose and 

treat these diseases. n

Watch Your Symptoms

Your doctor may not prescribe a 

treatment. If your symptoms are mild, 

the risks of treatment may be worse 

than the symptoms. But you should 

watch for signs that your disease is 

progressing.

• Visit your doctor regularly so that 

you can catch changes before they 

lead to serious damage. 

• Tell your doctor if your symptoms are 

flaring up. 

• Talk to your doctor before starting 

any alternative treatments, such as 

natural supplements.
Autoimmune Diseases 99

One Woman’s Story

As a 55-year-old female with diagnosed lupus since 1990, I have many stories to tell: 

the difficulty in obtaining a diagnosis, the problem with having good treatment options, the anxiety of introducing the disease to both my professional and social communities. I wondered if this disease would change my life goals.

There is also the problem of carrying a disease that does not provide real clues to those 

who witness the struggle. No one sees the fatigue, the joint pain, the internal damage. 

Therefore, you can’t be too sick. The other side of the coin is that I didn’t want to be 

known as the women with lupus. I wanted to be known as the incredible woman with 

loads of positive characteristics and personality who has lupus! 

Thankfully, I have found support in many 

ways and realized the importance of 

women in women’s lives. There are the 

wonderful women friends who attempt to 

understand and commit to befriending the 

disease as well as the person. I have also 

been fortunate to find a female nurse practitioner who researches and studies ways 

to assist in dealing with the disease and its 

challenges. 

And support groups are so important—not 

only for those who confront medical challenges, but because the support of each 

other as human beings allows us to feel 

loved, accepted, supported, and respected. 

An autoimmune disease can forever alter your self-image, the path you walk, and the 

journey you have painted for yourself. Once the diagnosis is made, the challenges accepted, and the choices identified, you can repaint your journey. Be an artist who accepts the 

challenge and is determined to continue the adventure, despite the bumps and curves in 

the path!

No one sees the 

fatigue, the joint 

pain, the internal 

damage.

Linda

Cody, Wyoming
100 The Healthy Woman: A Complete Guide for All Ages

For More Information...

Office on Women’s Health, HHS

200 Independence Ave SW, Room 712E

Washington, DC 20201

Web site: www.womenshealth.gov/faq/

autoimmune.htm

Phone number: (800) 994-9662, 

(888) 220-5446 TDD

National Institute of Allergy and Infectious Diseases, NIH

6610 Rockledge Dr, MSC 6612

Bethesda, MD 20892-6612

Web site: www.niaid.nih.gov

Phone number: (866) 284-4107, 

(800) 877-8339 TDD

National Institute of Arthritis and 

Musculoskeletal and Skin Diseases 

Information Clearinghouse, NIH

1 AMS Circle

Bethesda, MD 20892-3675

Web site: www.niams.nih.gov 

Phone number: (877) 226-4267, 

(301) 565-2966 TTY

National Institute of Neurological 

Disorders and Stroke, NIH

PO Box 5801

Bethesda, MD 20824

Web site: www.ninds.nih.gov 

Phone number: (800) 352-9424, 

(301) 468-5981 TTY

American Autoimmune Related Diseases 

Association

22100 Gratiot Ave

East Detroit, MI 48021-2227

Web site: www.aarda.org 

Phone number: (800) 598-4668 Literature 

requests, (586) 776-3900 Patient 

information

American College of Rheumatology

1800 Century Pl, Suite 250

Atlanta, GA 30345-4300

Web site: www.rheumatology.org 

Phone number: (404) 633-3777

American Thyroid Association

6066 Leesburg Pike, Suite 550

Falls Church, VA 22041

Web site: www.thyroid.org

Phone number: (800) 849-7643

APS Foundation of America

PO Box 801

LaCrosse, WI 54602-0801

Web site: www.apsfa.org

Arthritis Foundation

PO Box 7669

Atlanta, GA 30357-0669

Web site: www.arthritis.org

Phone number: (800) 283-7800 

Lupus Foundation of America

2000 L St NW, Suite 710

Washington, DC 20036

Web site: www.lupus.org

Phone number: (800) 558-0121 

Information request line

Myasthenia Gravis Foundation of 

America

1821 University Ave W, Suite S256

St. Paul, MN 55104

Web site: www.myasthenia.org 

Phone number: (800) 541-5454 

National Graves’ Disease Foundation

PO Box 1969

Brevard, NC 28712

Web site: www.ngdf.org 

Phone number: (877) 643-3123
Autoimmune Diseases 101

For More Information...

National Multiple Sclerosis Society

733 Third Ave

New York, NY 10017-3288

Web site: www.nationalmssociety.org

Phone number: (800) 344-4867

Scleroderma Foundation

300 Rosewood Dr, Suite 105

Danvers, MA 01923

Web site: www.scleroderma.org

Phone number: (800) 722-4673

Sjögren’s Syndrome Foundation

6707 Democracy Blvd, Suite 325

Bethesda, MD 20817

Web site: www.sjogrens.org 

Phone number: (800) 475-6473
102 The Healthy Woman: A Complete Guide for All Ages