Are Women More Prone to Autoimmune Diseases? 

A Keck Medicine of USC rheumatologist shares what women should know about autoimmune disorders. 

Ever been told that your joint pain is “probably just stress” — or that your fatigue is “normal for busy women”? In fact, these symptoms could be related to an autoimmune disorder. It’s also important to note that women develop autoimmune disorders four times more often than men.

“About 80% of autoimmune diseases affect women,” says Daniel Arkfeld, MD, a rheumatologist with Keck Medicine of USC. “This isn’t coincidence; it’s science.” 

Autoimmune conditions can occur at any age but typically develop in women between age 20 and 50, he says. Rheumatoid arthritis is one of the most common, causing joint pain, stiffness and potential joint damage. Lupus is less common but can affect women, impact multiple organs and cause fatigue and joint pain. Sjögren’s syndrome is another autoimmune disorder, one that is particularly common in women of Swedish and European descent and that primarily causes dry eyes and mouth. 

Why are women more prone to developing autoimmune conditions? Part of the reason is biological, Dr. Arkfeld says. Ahead, he explains warning signs and risk factors women should be aware of. 

Potential causes of autoimmune disease in women

Genetics and hormones can influence the development of autoimmune diseases, Dr. Arkfeld says. 

Genetics: Researchers posit that X chromosomes secrete factors that can trigger autoimmune responses. Because women have more X chromosomes — two X chromosomes in women (XX) compared to one X chromosome in men (XY) — women therefore have more immune-triggering signals. Testing this theory, researchers even studied men with Klinefelter syndrome, a condition in which men have an extra X chromosome (XXY). They found that these men with an extra X chromosome tend to develop lupus at the same rate as females. Pointing to another example of genetics playing a significant role in autoimmune diseases, Dr. Arkfeld says that identical twins have a 25% chance of both developing rheumatoid arthritis.

Hormones: Estrogen plays a role in autoimmune disease development, Dr. Arkfeld says. This explains why autoimmune conditions often appear or flare up during times of hormonal change. Key times of risk in a woman’s life are: 

• Puberty: New hormone surges can trigger the first symptoms of an autoimmune disease.
• Pregnancy and postpartum: While women with rheumatoid arthritis often see a reduction of symptoms during pregnancy, autoimmune conditions like lupus or rheumatoid arthritis frequently return six weeks after delivery.
• Menopause: Major hormonal changes can reactivate dormant autoimmune processes.

In addition, Dr. Arkfeld points out, having one autoimmune disease raises your risk of developing another. “Once you have one rheumatological antibody disease, you’re more likely to have a second one,” he says. Thyroid disorders, for instance, affect 15% of autoimmune patients compared to just 5% of the general population. 

Autoimmune diseases are often “invisible” 

Autoimmune diseases create “invisible” disabilities, meaning there may not be obvious physical signs that someone has a disease. “People with lupus often look completely normal, even during severe flares,” Dr. Arkfeld says.

This can be challenging for those with the disease, as even family members may not understand that even if their loved one appears otherwise healthy, they may be exhausted and struggling with symptoms. This disconnect can often lead to depression and feelings of isolation in patients with autoimmune disorders.

Warning signs of autoimmune disease 

Autoimmune diseases can be challenging to detect. “A lot of times it’s not totally obvious, even to primary care providers,” Dr. Arkfeld notes. Symptoms of autoimmune disease can mimic those of other conditions, making diagnosis challenging. 

What are the symptoms of autoimmune disease? Here are some red flags to report to your doctor: 

• Persistent joint pain or stiffness
• Unexplained, ongoing fatigue 
• Rashes that come and go 
• Dry eyes or mouth that don’t improve 

Dr. Arkfeld also notes that symptoms can vary by ethnicity. For instance, Caucasian women are more likely to develop rashes and joint pain, while Black and Hispanic women are more prone to having other organs impacted. 

Risk factors you can control 

While you can’t change your genetics or hormones, there are steps you can take to lessen certain autoimmune risk factors.

Avoid smoking and environmental toxins like air pollution, harsh chemicals and toxic household products. Avoid additives in processed foods that may trigger autoimmune responses. Stress can also exacerbate your risk. 

To lesson your risk, maintain regular exercise, get adequate sleep and practice healthy weight management. Adopt stress-reduction techniques and try to eat natural, unprocessed foods.

Also? Maintain good dental health: “Inflammation from the mouth seems to trigger rheumatoid arthritis flares,” Dr. Arkfeld warns. 

When to see a doctor 

If your symptoms are interfering with work, school or your daily activities, be sure to see a doctor. Early diagnosis significantly improves outcomes for all autoimmune conditions, Dr. Arkfeld says. Look for a health care provider who understands autoimmune complexity.

During your appointment, don’t accept dismissive responses that your pain could be “normal.” Even if initial lab test results look normal, this doesn’t mean you aren’t experiencing symptoms. Finally, consider seeing a rheumatologist if symptoms continue. 

Topics