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An Overview of

Autoimmune Disease

Autoimmune diseases occur when our own immune system begins to attack the body. The immune system is a complex system, playing a major role in protecting the body from disease. However, in some cases, the immune system may be tricked into triggering an immune response that instead attacks the body’s own organs and tissues, as well as the pathogens that cause infection.

The Immune System

To better understand how these situations in which the “body attacks itself” may lead to autoimmune disease, it helps to know some of the basics of immunology, such as the various organs, the cells they produce, and the roles these cells play in protecting us from illness. These basics include:

  • Lymphatic system: Made up of lymph fluid, lymphatic vessels, bone marrow, lymph nodes, spleen, and tonsils, the lymphatic system is critical in the elimination of toxic waste from tissues.
  • Antigen: A foreign substance that induces an immune response in the body.
  • T-cells: Considered the “warriors of the immune system,” these cells mature in the thymus enabling each individual T-cell to recognize only one of millions of antigens. T-cells then migrate into the lymphatic system and circulate in the blood.
  • Thymus: A flat, pinkish-gray gland, located in the upper chest in front of the heart, which T-cells pass through and mature.
  • Bone marrow: The tissue located within bones where immune cells are produced.
  • B-cells: Immune cells produced in the bone marrow, which then produce antibodies in response to an antigen.
  • Antibodies: Proteins produced by B-cells in response to a specific antigen. Antibodies neutralize the antigen and continue to circulate in the blood, providing protection against future exposures to that specific antigen.

Examining Possible Causes of Autoimmune Disease

Various underlying factors may influence or cause autoimmune diseases, including:

  • Viral infection
  • Bacterial infection
  • Stress
  • Genetic susceptibility

Infection, whether viral or bacterial, is especially regarded as a culprit as it has been found to precede the onset of autoimmune disease in many confirmed diagnoses. Viruses and bacteria gain access to our bodies by devising methods to avoid detection. Normally our immune system reacts by recognizing these antigens and then creating antibodies to combat them.

When discussing autoimmune diseases, the role played by T-cells is of great importance. As Lorna Vanderhaeghe and Dr. Patrick Bouic explain in The Immune System Cure, T-cells are taught to recognize the difference between invading cells and our own cells. Normally, the immune system attacks only substances and infections that are thought of as foreign to the body, such as invaders from outside the body (viruses or bacteria), or cancer cells made within the body; however, sometimes the immune system may become confused and attack healthy body cells.

Examples of Autoimmune Diseases

There are myriad different autoimmune diseases, but while each may affect different parts of the body, each involves the immune system mistakenly attacking the body. For example, this article will look at a few of the most common: thyroid dysfunction, lupus, multiple sclerosis (MS), and rheumatoid arthritis (RA). However, other associated conditions include, but are not limited to:

Condition Main Affected Area
Addison’s disease Adrenal glands
Ankylosing spondylitis Spine
Autoimmune hemolytic anemia Red blood cell membranes
Crohn’s disease Gut
Graves’ disease Thyroid
Hashimoto’s disease Thyroid
Type 1 diabetes Cells that secrete insulin
Multiple sclerosis (MS) Brain and spinal cord
Myasthenia gravis Nerves and muscles
Psoriasis Skin
Rheumatoid arthritis (RA) Cartilage and joint linings
Sjögren’s syndrome Salivary and tear glands

Thyroid Dysfunction

Two general autoimmune diseases target the thyroid:

  • Graves’ disease – Generally associated with overactive thyroid (hyperthyroidism)
  • Hashimoto’s thyroiditis – Generally associated with underactive thyroid (hypothyroidism)

Both forms of thyroid dysfunction are more common in women than men, and are often first diagnosed in individuals between the ages of 20 and 30 years.

Because the thyroid gland controls the metabolic activity of our body, dysfunction of this gland affects metabolism. In the case of Graves’ disease, the body’s antibodies attack the thyroid gland, resulting in its inflammation and swelling of the thyroid gland. This leads to an overactive metabolic state, causing an increase in heart rate, blood pressure, and calorie burning rate.

Treatments for Graves’ disease include radioactive iodine (RAI) treatment, anti-thyroid medications, and/or surgical removal of the thyroid. RAI treatment and surgery usually disable all or part of the thyroid, eventually causing hypothyroidism. Thyroid hormone therapy may be used to make up for thyroid deficiency, but does not address original underlying cause of the dysfunction.

Like Graves’ disease, Hashimoto’s thyroiditis is an autoimmune disease where antibodies react against proteins on the thyroid; however, this disease is characterized by a gradual destruction of the gland itself and its ability to produce the thyroid hormones needed by the body. People with hypothyroidism experience lowered metabolic activity. Doctors typically prescribe thyroid hormone therapy for hypothyroidism caused by Hashimoto’s thyroiditis.

Symptoms of Graves’ Disease May Include: Symptoms of Hashimoto’s Thyroiditis May Include:
Anxiety Feeling cold
Sweating Dry skin
Difficulty sleeping Constipation
Protruding eyeballs Fatigue

Systemic Lupus Erythematosus (SLE)

Often referred to simply as “lupus,” SLE is a chronic autoimmune disease that affects various parts of the body, particularly the skin, blood, joints, kidneys, lungs, and heart. It is caused by an overactive immune system that produces antibodies that attack the body’s own organs, joints, and tendons. The result is the formation of immune cell complexes, which build up in various tissues and cause pain, inflammation, and eventual injury or destruction.

In Living Well with Autoimmune Diseases, Mary Shomon writes: “For most, lupus is considered a mild condition, affecting only a few organs. For others, however, it may not take such a simple course and may trigger serious, even life-threatening, conditions.” Lupus may occur at any age, and while it is found in both men and women, it is more prevalent in women.

DHEA and Lupus

Medical studies have found the use of dehydroepiandrosterone (DHEA) to improve the health of people with lupus. A hormone produced by the adrenal glands, DHEA is a major precursor, or building block, to the sex hormones. Sex hormones include androgens (such as testosterone) and estrogens and play a variety of roles in the body to help maintain health.

Studies have shown that some lupus patients have low levels of DHEA and that this may contribute to the onset of the disease. Therefore, it is thought that increasing the level of androgens may help promote autoimmune function. In the scientific review DHEA For Lupus, Dr. Kay Shaver concludes that the use of DHEA may provide lupus patients with several benefits including the potential to provide relief from symptoms, a decrease in the frequency of disease flare-ups, and possibly even combat the destructive effects on bone health.

Multiple Sclerosis

Multiple sclerosis is another chronic inflammatory autoimmune disease, but this one specifically targets the central nervous system, affecting the brain and spinal cord. In MS, the body overproduces antibodies that specifically attack myelin (the protective sheath that covers our nerves) and can result in a variety of neurological problems. These problems include:

  • Cognitive and psychological changes
  • Weakness or paralysis of limbs
  • Numbness
  • Vision problems
  • Speech difficulties
  • Problems with walking and motor skills
  • Sexual dysfunction

MS is the most commonly acquired neurological disease in young adults. While it can affect anyone, it is most often diagnosed in individuals between the ages 20 and 40. Like many autoimmune diseases, MS is more prevalent in women, affecting twice as many women as men.

Estrogens and MS

Some important studies were created after repeated observations that, upon becoming pregnant, women with MS showed a significant improvement in their symptoms and a decrease in their relapses or flare-ups. The effects of oral hormonal treatment for MS were tested by Dr. Nancy Sicotte et al. who demonstrated that estriol, a hormone elevated during pregnancy, helped to decrease MS symptoms when given to non-pregnant women with MS. More extensive trials in animals with MS confirmed that various doses of estriol work to stabilize and even improve symptoms in this debilitating disease.

Progesterone and MS

Progesterone has also been implicated in the possible treatment of MS. Dr. Herbert Koenig et al. showed in a laboratory study that progesterone may be involved in the process of myelination, or the formation of myelin to protect nerve cells. Their work suggests that the administration of progesterone may be a valuable therapeutic approached for supporting myelin repair in MS patients.

Vitamin D and MS

MS has been linked to deficiencies of vitamin D, which is actually a hormone related to the sex and adrenal hormones. In The Vitamin D Revolution, Dr. Soram Khalsa writes that vitamin D has been suggested as “a possible treatment for MS symptoms, as studies indicated that people with MS have more lesions in the winter than the summer,” which is in turn linked to limited sunlight exposure and lower vitamin D synthesis. While the findings of current studies have shown potential, Dr. Khalsa believes that “many more years of prospective studies are required before we can make solid recommendations.”

Rheumatoid Arthritis

Rheumatoid arthritis is a widespread and disabling autoimmune disease that affects the joints (most frequently the free-moving joints such as hands, knees, or hips) and muscles. In RA, the body launches an autoimmune attack on the synovial membranes (the tissue that lines and cushions the joints), leading to inflammation, tissue thickening, and pain. As this process continues, the pain and swelling increase which may result in destruction and deformity of the bones.

Symptoms of RA usually begin between the ages 25 and 50, and perhaps because it is so common, the symptoms are often mistaken as a normal part of aging. Women are afflicted two to four more times frequently than men. For most patients, RA is progressive despite treatment, so the objective of treatment is confined primarily to controlling inflammation, preventing or slowing joint damage, and ultimately easing the condition into remission.

Progesterone and RA

A small study by Dr. Miguel Cuchacovich, et al. indicated the possible benefits of using progesterone treatment in patient with RA. After twelve RA patients received a single intraarticular injection of progesterone, ten of them observed local declines in inflammation for at least one month, with some effects lasting up to two months. While no major adverse effects were reported, the researchers recommended a more prolonged follow-up “is necessary to rule out the late onset of side effects.”

Testosterone and RA

In the article Hormonal pattern in women affected by rheumatoid arthritis, Dr. Rossella Valentino et al. noted decreased levels of testosterone in RA patients. The researchers go on to describe how laboratory and clinical studies have shown positive effects when testosterone replacement therapy is used. Dr. David Brownstein agrees, writing in Overcoming Arthritis that in his experience, “most patients who are ill from an autoimmune disease, such as rheumatoid arthritis or Lupus, have depressed levels of testosterone. These patients generally respond favorably to small amounts of natural hormones, including natural

The Endocrine System and Autoimmune Diseases

As the body’s hormonal regulator, the endocrine system releases and then slows and/or stops the production of different hormones in response to various internal and external triggers. The tightly-controlled network of endocrine organs (such as ovaries and testes) and endocrine glands (including the thyroid, pancreas, pituitary, and adrenal glands) may be affected in cases of autoimmune disease. In cases of insulin-dependent diabetes, the pancreas comes under attack, while in Graves’ disease, as discussed earlier, the thyroid gland goes into overdrive in response to the overproduction of antibodies.

Autoimmune diseases involving the endocrine system may also occur when a person produces antibodies to a particular hormone. Antibodies may wreak havoc against naturally occurring hormones such as estradiol and progesterone. For example, when women produce antibodies to their hormones, they may experience erratic ovulation or irregular thickening of the uterine lining; these conditions may cause abnormal menstrual periods or even prevent successful embryo implantation and pregnancy.

The Role of Estrogen in the Immune System

“As it turns out, one of the greatest factors that influence the immune system is gender,” writes Dr. Robert Lahita in Women and Autoimmune Disease. While these conditions also afflict men, they are much more prevalent in women. The authors of The Immune System Cure suggest the following explanation of this gender disparity:

Scientists believe that the female hormone estrogen may be the reason for this. The hormone estrogen may interplay with certain immune factors that enhance the action of the inflammatory response, increasing antibodies that attack certain tissues in the body. An overabundance of estrogen or estrogen-dominance may be a factor in the prevalence of autoimmune conditions in women.

Other studies indicate that women tend to have a more vigorous immune response during their reproductive years when estrogen levels are higher. It is during menopause, when estrogen levels decrease, that a woman’s immune system becomes more similar to that of a man’s. This lowered immune response is believed to be caused by changes in the function and activity of certain immune cells. The incidence of many autoimmune diseases in women dramatically decreases following menopause.

In a review of various studies designed to better understand the relationship between sex hormones and the immune system, Dr. Sarit Aschkenazi et al. explain that sex hormones such as estrogens affect and modify the actions of different types of immune cells. Certain interactions between estrogen and cells of the immune system may also influence other organs of the body that are not directly related to immunity. For example, cardiovascular disease and osteoporosis—health issues that often affect women after menopause—are linked to a decrease in estrogen and a loss in estrogen’s ability to regulate the healthy functioning of other types of immune cells.

Dr. Aschkenazi et al. concluded that sex hormones, in particular the estrogens, play a role in the activity of immune cells. Furthermore, a deficiency in estrogen that occurs during menopause may result in a failure of estrogen to properly regulate the immune system. These changes, in turn, may play an important role in the development of menopausal symptoms and disease.

Conclusion

Because many different kinds of proteins and molecules comprise our immune system, it is often a challenge to understand how and why a “crossed signal” in that system may lead to autoimmune disease. Given the complexity of a properly functioning immune system, it is easy to see why autoimmune disorders are so prevalent worldwide. However, research has shown that, in some instances, maintaining hormone balance may be a significant factor in supporting immune system health.

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  • Shomon MJ. Living Well with Autoimmune Disease. New York, NY; HarperCollins: 2002.
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  • Shaver K. DHEA for Lupus. Pharmacist’s Letter/Prescriber’s Letter. 2000.
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  • Koenig HL, et al. Progesterone synthesis and myelin formation by Schwann cells. Science. 1995 Jun 9;268(5216):1500-3. doi: 10.1126/science.7770777.
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  • Khalsa S. The Vitamin D Revolution: How the Power of This Amazing Vitamin Can Change Your Life. Carlsbad, CA; Hay House, Inc.: 2009. Pages 118 and 125.
  • Valentino R, et al. Hormonal pattern in women affected by rheumatoid arthritis. J Endocrinol Invest. 1993 Sep;16(8):619-24. doi: 10.1007/BF03347683.
  • Brownstein D. Overcoming Arthritis. West Bloomfield, MI; Medical Alternatives Press: 2001. Pages 22-23 and 97.
  • Cuchacovich M, et al. Intraarticular progesterone: effects of a local treatment for rheumatoid arthritis. J Rheumatol. 1988 Apr;15(4):561-5.
  • Aschkenazi S, et al. Menopause, Sex Hormone and the Immune System. Menopause Management. Mar/Apr 2000.

Connections is a publication of Women’s International Pharmacy, which is dedicated to the education and management of PMS, menopause, infertility, postpartum depression, and other hormone-related conditions and therapies.

This publication is distributed with the understanding that it does not constitute medical advice for individual problems. Although this material is intended to be accurate, proper medical advice should be sought from a competent healthcare professional.

Publisher: Constance Kindschi Hegerfeld, Executive VP – Women’s International Pharmacy
Editors: Julie Johnson; Michelle Violi, PharmD – Women’s International Pharmacy
Writers: Carol Petersen, RPh, CNP; Laura Strommen – Women’s International Pharmacy

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