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Women's Autoimmune Diseases: Rheumatoid Arthritis

Ann Witt, M.D., and Natalie Staats Reiss, Ph.D., edited by Benjamin McDonald, MD

Our immune system protects us from diseases. Ideally, antibodies, which are part of the immune system, recognize and destroy infections like bacteria and viruses so we do not get sick. To do this successfully, our body must be able to distinguish between "self" and "non-self" (e.g., bacteria and viruses).

body imageAutoimmune diseases occur when the body misinterprets "self" as "non-self," resulting in the destruction of its own cells. The causes of autoimmune disease are unclear. It appears that multiple genes work together to make an individual vulnerable and ultimately, a trigger occurs that disrupts proper functioning of the immune system. The trigger may be an infection, medication, or environmental exposure, but often it is unknown.

Of people with autoimmune conditions, 75% are women. The two most common conditions are rheumatoid arthritis and autoimmune thyroiditis. Other types, while relatively rare, include multiple sclerosis, psoriasis and lupus. Lupus is primarily a women's disease- approximately 90% of lupus patients are female.

Rheumatoid Arthritis

Rheumatoid Arthritis is a chronic disease that results in inflammation and swelling of the joints. The disease can affect other parts of the body besides the joints including skin, blood vessels, heart, and lungs. The majority of RA patients develop their condition between 35 and 50 years old. Two-thirds of people with rheumatoid arthritis are women. As with other autoimmune diseases, Rheumatoid Arthritis is thought to be caused by a combination of genetics risks possibly triggered by infections or exposure to an unknown substance in a person's environment. However, the cause remains unknown.

Symptoms:

Rheumatoid arthritis causes persistent inflammation in the joints of the hands, feet, ankles, wrists, knees and elbows. This disease also results in destruction of the joints. The inflammation and breakdown of joint tissue causes swelling, tenderness, stiffness, and a decrease in range of motion (ability to move around a joint). Typically, the stiffness is worse in the morning or after times of inactivity. Women with RA may also experience tiredness, weight loss, fever, and weakness.

Diagnosis:

There is no single test used to diagnose rheumatoid arthritis. Often the diagnosis is made after a history and physical exam. There are seven diagnostic criteria, which include:

1. Morning stiffness
2. Arthritis in 3 or more joint areas
3. Arthritis of the hand joints
4. Symmetric arthritis (i.e. arthritis involving both hands, not just one)
5. Rheumatoid nodules (a bump measuring up to a couple of centimeters that is located just under the skin, typically near a bone such as the elbow. It develops partially from inflammation of blood vessels)
6. Elevated rheumatoid factor (found with a blood test)
7. Radiographic changes (destruction or wearing away of the bone evident in an x-ray of the joints)

Because rheumatoid arthritis shares many symptoms similar to viral syndromes such as tiredness, fever, and soreness, at least 4 of the above criteria must be present for at least 6 weeks for a diagnosis of RA. Sometimes, lab tests (e.g., rheumatoid factor, erythrocyte sedimentation rate, C-reactive protein) are used to rule out other causes of symptoms. Also, lab tests (such as examining the fluid around a joint for inflammation) can be used to indicate the severity of a person's disease. X-rays are used to examine the joints and look for evidence of bone destruction, as well as monitoring the effects of treatment. However, X-rays are often not helpful early on in the disease because the destruction is not yet visible.