Women and Autoimmunity

Autoimmune diseases like lupus, rheumatoid arthritis, and sclerosis affect more women than men.1 Out of every 10 people with autoimmunity, 8 to 9 are women.1 Autoimmunity occurs when the body’s main defense, the immune system, misfires, and attacks itself. Genetics may play a role in why a woman’s immune system is more likely to misfire.1 Environmental effects might increase autoimmunity risk.

Immune responses

The immune system

When the body senses a foreign intruder, like bacteria or viruses, it activates the immune system. There are 2 types of responses, the innate and acquired responses.2 Innate and acquired immunity work together to kill bacteria, fungi, and viruses.

Innate immune response

Cells of the innate response are always in your blood patrolling for threats. The cells involved are macrophages, basophils, neutrophils, and dendritic cells.2 Innate immunity is a “one size fits all” approach.2 The cells are ready to fight any and all intruders immediately.2

Acquired immune response

The acquired response is slower. The body custom-makes acquired cells as opposed to having them pre-made. There are 2 types of acquired immune cells:2

  • B cells – each type of B cell fights a particular type of bacteria or virus.
  • T cells – kills intruders directly (killer T cells) or urges the body to make more B cells (helper T cells).

Once a B cell is made, it stays in your body. This primes your immune system to attack the intruder if it returns. This is how vaccines work.

How autoimmunity affects the immune system

In autoimmune diseases, the body thinks it needs to fight itself. The body then makes B cells to attack its tissues. B cells target different tissues that cause different autoimmune diseases with different symptoms.3 Many autoimmune drugs are immunosuppressants. These drugs lower the B cell response.

A 2016 study on rheumatoid arthritis found that the immune system was triggered by trauma to the skin.4 A 2006 study showed lupus was also triggered by skin damage like ultraviolet light.4 It is unknown whether all autoimmune diseases are triggered similarly. Once the initial trauma happens, genetics may play a role in why a woman’s immune system is more likely to attack itself.1

Men vs. women

Doctors think in some ways, women have a stronger immune response than men.5 Women have more B cells.5 Men and women’s immunological response to trauma is different.1,4 With more B cells and different immune responses, women’s immune systems may be more likely to make mistakes.5 Environment and lifestyle may also affect immune responses.1

Genetics and autoimmunity

The immune systems of men and women differ partly because of our genes.1 Genes determine every part of who we are from eye color to how well our immune system works.1 Doctors have found 2 genes, BAFF and VGLL3, that are different in men and women. These genes may be part of the reason that gender is a risk factor for lupus.1,4

B cell-activating factor (BAFF)

BAFF causes your body to make B cells which can then attack your tissues.6 People with lupus have too much BAFF.6 A lupus drug called Belimumab stops BAFF from being active.6 A 2019 study showed that Belimumab lowered BAFF levels and B cell levels. This could protect you from autoimmune damage.6

Testosterone lowers BAFF which lowers B cell levels.3 Males have more testosterone than females.3 Testosterone is one way that hormones may protect men from autoimmunity.3

Vestigial-like family member 3 (VGLL3)

VGLL3 turns on the immune response and causes inflammation.4 A 2019 study showed that having a lot of VGLL3 makes you more likely to get lupus.4 Women have a lot of VGLL3, but healthy men do not.4,7 Although, men with lupus have a lot of VGLL3.4,7 Doctors are looking at VGLL3 for a potential new drug target.4

Lifestyle and autoimmunity

Smoking and being around silica raises your risk of autoimmunity.1 Chemicals called aromatic amines are linked to autoimmunity and cancers.8 These are found in hair dyes, some meats, and in industrial settings.8 Although, one study showed that hair dye does not raise the risk for lupus.1 Lipstick may be linked to lupus, but having breast implants was not.1

Location and autoimmunity

Where you live could impact autoimmunity. The United States has higher rates of lupus than the United Kingdom.1 Rheumatoid arthritis is more frequent in northern Europe and North America.1 Doctors do not know why the location affects disease rates.

Age, race, and autoimmunity

Autoimmunity usually strikes in child-bearing years.1 This suggests hormones impact autoimmunity. Lupus affects African American women at 3 times the rate of Caucasians.9 In fact, those with Hispanic, Asian, Alaskan, or Native American heritage have a higher chance of getting lupus.9 African American and Hispanic women have worse lupus progression.9

Decreasing risk

Doctors have not yet figured out all the genes involved in autoimmunity or how the environment plays a role. Being healthy is the best way to lessen your chance of disease. Eat a balanced diet, exercise, and do not smoke. See your doctor regularly. If you have a family member with autoimmunity, make sure your doctor knows.

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