Transcript Women and Auto-immune Disease

Bernadette C. Siaton, MD
Assistant Professor of Medicine
Division of Rheumatology and Clinical Immunology
University of Maryland School of Medicine
 NONE
 By
the end of this talk, you should be able
to:



Describe the differences between arthralgia and
arthritis
Recognize the symptoms of autoimmune disease
symptoms
Recognize the symptoms of two common
autoimmune connective tissue diseases


Lupus and rheumatoid arthritis
Recognize the symptoms of fibromyalgia
 Describe
the differences between
inflammatory joint pain and noninflammatory joint pain
 Overview of autoimmune disease and its
symptoms and treatment
 Briefly discuss some common autoimmune
connective tissue diseases

–Lupus and rheumatoid arthritis
 Provide
an overview of fibromyalgia
ARTHRITIS
DIAGNOSIS
 Joint pain
 Inflammatory




Swelling
Redness
Tenderness
Limitations in range
of motion
 Stiffness

ARTHRALGIA
SYMPTOM
 Joint pain
 Non-inflammatory
 Pain without swelling
 “achiness”

 Varied
group of illnesses that can involve any
human organ system

Nervous, gastrointestinal, endocrine, skin, and
connective tissues
 The
body’s immune system becomes
misdirected and attacks its own organs and
tissues
 Diseases may affect several systems so many
different types of doctors may be involved in
treatment
 More
than 80 types of autoimmune disease
 Autoimmune diseases range from very
common to very rare
 Some of the more commonly recognized
autoimmune diseases include Hashimoto’s
thyroiditis, lupus, and Grave’s disease
 23.5-50
million Americans have autoimmune
disease
 75% are women!!!
 NIH estimates the impact of auto-immune
disease is more than $100 billion dollars in
direct healthcare costs


www.aarda.org
Cancer $57 billion
Heart and strokes $200 billion
 Top
10 cause of death in US women >65 years
old
 4th leading cause of disability in US women
 In the US the overall risk of developing
autoimmune rheumatic disease is:


8.4% (1 in 12) for women
5.1% (1 in 20) for men
Disease
Female:Male Ratio
Hashimoto’s thyroiditis
10:1
Systemic lupus erythematosus
(Lupus)
9:1
Sjogren’s syndrome
9:1
Primary biliary cirrhosis
9:1
Autoimmune hepatitis
8:1
Graves’ disease
7:1
Rheumatoid arthritis
2.5:1
Anti-phospholipid syndrome
(primary)
2:1
Multiple Sclerosis
2:1
Myasthenia gravis
2:1
 Women
of childbearing age
 Family history of autoimmune disease
(genetics)
 People of certain race or ethnic background
(genetics)
 Environmental exposures
 45%
are labeled chronic complainers early in
the disease
 Most patients wait 4.6 years for a formal
diagnosis and see 5 different doctors/
medical professionals
 Many of the symptoms are not specific and
may be seen in many other diseases

Fatigue, pain, hair loss
Disease
Symptoms
Alopecia areata
Patchy hair loss on the scalp, face, or other
areas of the body
Vitiligo
White patches on areas of skin, loss of skin color
Graves’ disease
Difficulty sleeping, weight loss, temperature
sensitivity, weakness, tremors
Hashimoto’s
disease
Fatigue, weakness, weight gain, muscle aching,
stiff joints, constipation
Celiac Disease
Abdominal bloating, diarrhea or constipation,
fatigue, rashes, difficulty getting or staying
pregnant
Psoriasis
Thick red patches of scaly skin on head, elbows,
knees, itching, joint pain and swelling (psoriatic
arthritis)
Disease
Symptoms
Lupus
Fever, weight loss, hair loss, fatigue, rashes,
joint pain, sun sensitivity
Scleroderma
Fingers that change color in cold, pain and
swelling in joints, thickening of skin, difficulty
swallowing, diarrhea or constipation
Sjogren’s
syndrome
Dry eyes, dry mouth, fatigue, joint swelling or
pain, swollen glands
Rheumatoid
arthritis
Painful, stiff, swollen joints. Deformities in
joints, fatigue, fever, weight loss, eye pain
Anti-phospholipid
syndrome
Blood clots in your veins and arteries, multiple
miscarriages, lacy skin changes
 Chronic
autoimmune disease that affects
more than 1.5 million Americans
 90% of persons affected are women
 African Americans and Hispanics are more
often affected than whites
 Most women diagnosed in child-bearing years

age 15-44
 16,000

new cases in the US each year
5 new cases per 100,000 people
3



different types
Systemic lupus –affects various parts of the body
Cutaneous lupus –affects skin only
Drug-induced lupus –triggered by certain
medications
 Diagnosis
based on a combination of clinical
findings AND lab tests
 Pain
and swollen joints
 Color change in the fingertips
 Sores in the mouth and nose
 Rashes when exposed to the sun
 Fever
 Chest pain with breathing
 Protein in the urine
 Fatigue
 Depression or memory problems
 Hair loss
 Treatment
is dependent on the symptoms
 Sometimes drugs are used to suppress the
immune system

Steroids, anti-malarials, disease modifying antirheumatic drugs (DMARDS)
 Other
treatments are aimed at controlling
symptoms

Pain medications
 Regular
medical visits
 Exercise
 Healthy diet
 Sun avoidance
 Stress Reduction
 Common
type of inflammatory arthritis
 Affects small joints of the body

Wrists, hands, ankles, feet, elbows, neck
 Patients
may have several hours of stiffness
in the morning or after sitting for too long
 RA is associated with swelling and tenderness
of the joints
 Commonly patients have difficulty using
hands –opening jars, turning doorknobs, etc.
 The
cause of RA is unknown, probably a
combination of genetics and environmental
factors
 Smoking may increase risk of developing
RA or may make RA disease worse
 Annual incidence is 40 case per 100,000
persons
 Prevalence about 1 percent of Whites, but
may be increased in other populations
 Risk of developing RA is 1 in 28 for women
and 1 in 59 for men
 Goals




of treatment
Stop inflammation (remission)
Relieve symptoms
Prevent long term damage
Preserve functionality and well-being
 Medications



Suppress the immune system
Help with symptoms (pain)
steroids, disease modifying anti-rheumatic drugs
(DMARDS), biologic drugs
 Surgery
 Physical
 Exercise
Therapy
 Classically
known as degenerative arthritis or
“wear and tear” arthritis
 Joint space narrowing, loss of cartilage
 May affect neck, back, hips, knees, and
hands
 Pain usually gets worse with activity and
better with rest
 Morning stiffness usually less than 30 minutes
 Risk factors:

Age, female sex, obesity, previous injury,
occupation, muscle weakness, genetic factors
 Medications






Acetaminophen
NSAIDS –ibuprofen, naproxen
Steroid injections
Opioid medications
Intra-articular hyaluronic acid injections
Glucosamine and chondroitin
 Non-medication


treatments
Exercise programs, weight loss
Joint replacement for severe cases
 If
you are having symptoms that bother you
then get checked out!





Write down a complete family health history and
share with your doctor
Start with your primary care doctor who can help
with referrals to specialists
See a specialist who has experience dealing with
your biggest symptom
Get a second, third, etc opinion if necessary.
Be your own health advocate
Nephrologists (kidney)
 Rheumatologists (arthritis and connective tissue)
 Endocrinologists (gland and hormones)
 Neurologists (brain and nerve)
 Hematologists (blood diseases)
 Gastroenterologists (digestive system)
 Dermatologists (skin)
 Physical therapists and occupational therapists
 Speech therapists
 Audiologists (hearing)

 Many
diseases have no cure but can be
controlled with medications
 Periods
of flare and remission
 Medications



Suppress immune system
Replace substances that the body can no longer
make on its own (thyroid hormones, insulin)
Symptom relief
 Eat


healthy, well-balanced meals
Low fat
Lots of fruits and vegetables
 Regular


physical activity
Low impact, as tolerated
Walking, swimming, zumba
 Rest
 Integrative



Acupuncture
Nutrition
Fitness
 Stress

medicine
reduction
mindful meditation, yoga, tai chi
 Educate
disease
 Build
yourself and others about your
a support system
 These
are NOT auto-immune diseases
 Share similar symptoms
 Fatigue, weakness, muscle and joint pain,
forgetfulness, difficulty sleeping
 May co-exist with auto-immune disease
 Chronic
widespread pain
 Affects 2-4% of the population

5
More commonly affects women
million Americans age 18 or older
 Unknown cause, but there is an association
with a mentally or physically traumatic event
 There may be an abnormality in how the
central nervous system processes pain
 Diagnosis of exclusion
http://www.beingfibromom.com/wp-content/uploads/2014/03/fm-symptoms.jpg
 Treatment

of mental health disorders
Counseling, medications, psychotherapy
 Low-impact

Walking, aquatic and physical therapy
 Good

exercise
sleep hygiene
Sleep study to rule out sleep apnea
 Other

Meditation, tai-chi, acupuncture
 Depart
of Health and Human Services
www.womenshealth.gov
 American Autoimmune Related Disease
Association, Inc. www.aarda.org
 Arthritis Foundation www.arthritis.org
 Lupus Foundation of America www.lupus.org