Autoimmune Diseases in Women

[Guest guest]

I found three interesting articles on Medscape regarding autoimmune

diseases.

Matija

Clinical Discussion on . . .

Autoimmunity: The Female Connection

3/23/98

As a psychiatrist treating many adult women who were sexually abused as

children, I have observed an apparantly high incidence of autoimmune

difficulties in these clients. I have wondered if psychological/physica

l trauma causes reductions in DHEA, which then mediates the development

of subsequent physical symptomatology. It is noteworthy that the

research suggests that as many as one third of women report having been

sexually abused as children, (much higher incidence than reported with

men), and women have the lion's share of autoimmune disorders. I think

it would be very interesting to study populations of 20-30 year old

women with a history of severe childhood abuse/sexual abuse, by

measuring their DHEA-S levels, at least as a starting point.

V. Satchell, MD

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2/18/98

Rheumatoid arthritis and lupus result from cortisol deficiency,

primarily as a result of thyroid deficiency, not thyroxine (T4)

deficiency, but triiodothyronine (T3) deficiency in the presence of a

relatively normal T4 level. The problem that should be looked into in

these patients is the level of reverse T3 (rT3) which when present may

hog too much of their base, T4, to allow sufficient T3 production

result in what could be called rT3 hypothyroidism. When there is a

deficiency of T3, the adrenals are unable to produce the added cortisol

necessary when the factors responsible for rheumatoid arthritis and

lupus appear. The supplementation with T3 will not cure the problem,

but its addition will enhance the other treatment modalities. If the T3

deficiency is treated optimally before the insult, it will probably

prevent the RA and lupus.

R. M. Alford, MD

Autoimmunity: The Female Connection

Authors: Joan T. Merrill, MD, Anca R. Dinu, MD, G. Lahita, MD,

PhD

Abstract: The prevalence of autoimmune diseases in women may be the

consequence of a bidirectional signaling network between hormones and

the immune system that regulates female reproductive life. Two

prototypical autoimmune diseases, rheumatoid arthritis and systemic

lupus erythematosus, arise from 2 different immune responses that

generate mutually exclusive signals in response to different

inflammatory triggers. Certain estrogens may ameliorate the

rheumatoid-arthritis-like TH1 response while exacerbating the

lupus-like TH2 response. Studies of sex hormone metabolism in lupus

patients reveal increased 16-hydroxylation of estrone in some patients

and decreased levels of androgens as a result of increased oxidation at

C17. These occurrences result in low serum levels of

dehydroepiandrosterone (DHEA). Both the increase of 16-hydroxylation of

estrone and the depletion of DHEA have immune effects that would tend

to exacerbate a lupus-like TH2 response. This theoretical framework

provides a rationale for ongoing initial clinical trials of exogenous

hormones in autoimmune diseases. [Medscape Women's Health 1(11), 1996.

© 1996 Medscape, Inc.]

Key words: Systemic lupus * Rheumatoid arthritis * Autoimmunity *

Estrogen * Progesterone * Dehydroepiandrosterone * Androgens