| Abstract: |
The autoimmune diseases are more common in women than men.The
actual prevalence ranges from the high of 10 to 15 females for eachmale
for systemic lupus erythematosus to four females for every male with rheumatoid
arthritis. Though these diseases are found in the veryyoung and
the aged, the high prevalence is observed after puberty in mostpatients.
These diseases vary with regard to severity, and most investigators suspect
that the signs and symptoms of these diseases vary with menstrual cycle
and change severity during pregnancy. The collagen diseases are devastatingto
the health of young women. Rheumatoid arthritis occurring ata mean
age of 40 years results in debilitating erosive changes in bonewith morning
stiffness and eventual crippling. Systemic lupus erythematosus, Sjogren's
syndrome and others, common to women of the childbearing years,act in several
ways to destroy organ systems of the body. Virtually anyorgan system of
the female anatomy can be affected by these illnesses.In the case of lupus,
the disease has protean manifestations, such as procoagulation, renal destruction,
skin disease, unrelenting arthropathy and arthritis,and encephalopathy
(to name only a few). The underlying mechanisms arenot known; however,
the immune system acts to destroy tissue via immunecomplex deposition and
through the action of cytotoxic lymphocyte activity.There is an association
of both clinical signs and autoantibody subpopulationswith markers of the
HLA-D or MHC II locus on chromosome 6. No constitutivegene for any of the
collagen vascular diseases has been identified in the human. Evidence exists
to support an altered metabolism of estrogens andandrogens in patients
with these diseases. Recent data also indicate that increased estrogen
levels might initiate autoimmune diseases in many womenand men. Estrogen
hydroxylation is increased in both men and women with autoimmune diseases
like lupus. The mechanisms are unknown, although estrogenicmetabolites
have been shown to increase B cell differentiation and activateT cells.
Moreover, isolated cases of hyperprolactinemia have been observedin association
with these hyperestrogenic states, and treatment of hyperprolactinemiahas
been shown to ameliorate diseases like lupus. Androgen oxidation isalso
increased in patients with autoimmune disease, but this abnormalityhas
been observed only in patients with lupus, and only women at that.The result
is that women with autoimmune diseases like lupus and rheumatoid arthritis
have lower plasma androgens than control cases. These data have supported
the use of weak androgens, e.g., DHEA, for thetreatment of lupus. |
