Men and Autoimmune Disease

Image by lhumble

Girls.

The time has come to admit that we are not an exclusively female club. It's time to let the guys into our autoimmune tree house, boy cooties and all.

While it is true that the ratio of women to men is 9:1 for Sjogren's syndrome and SLE, a recent report published in September 2009 by the Annals of Internal Medicine spurred interest in AIs in men after it was revealed that John F. Kennedy dealt with significant health issues stemming from autoimmune disease:

At the age of 43 years, John F. Kennedy was the youngest man ever elected president. Throughout both his campaign and hispresidency, he was portrayed as the epitome of youth and vigor. In fact, he had the most complex medical history of anyone to occupy the White House. The recent opening of his White House medical records has provided researchers greater insight into the multiple medical conditions that afflicted Kennedy. A recent review of these records, coupled with other available sources, allows new understanding of his health history that can now be explained in the context of a unifying autoimmune endocrine disorder.

.......In summary, John F. Kennedy had many medical conditions during his lifetime. Addison disease was diagnosed when Kennedy was 30 years of age, and he was found to have hypothyroidism when he was a senator. The coexistence of autoimmune adrenal disease and hypothyroidism is consistent with APS 2......Despite his many medical conditions as well as his recurrent back problems, John F. Kennedy managed to convey an image of health and vigor that masked the true state of his health to the U.S. public.

John F. Kennedy may have had autoimmune polyendocrine syndrome type 2, or APS2, which may include Addison's disease and hypothyroidism among other problems. You can read more about APS2 here.

While APS2 is relatively rare, other autoimmune diseases found in men are not. Note the ratio of male/female in ulcerative colitis, diabetes mellitus, and myocarditis in the graph below.

Graph above found here, from the CDC.

Why are autoimmune diseases so sharply divided between the sexes? This remains a very difficult question and the definitive answer has yet to be found. This National Women's Health Resource article offers a few explanations, most based on sex hormonal differences between men and women:

Most researchers agree on one thing: sex hormones must be involved. For instance, symptoms of multiple sclerosis and rheumatoid arthritis tend to improve during pregnancy, when levels of estrogen and progesterone are high. They also tend to improve when women take oral contraceptives, which moderate hormone fluctuations.²Autoimmune thyroid disease also may improve during pregnancy, then flare after delivery as postpartum thyroiditis.

Lupus, however, might sometimes flare during pregnancy while some other autoimmune diseases show no hormone-related disease changes.²

Another theory suggests that fetal cells from earlier pregnancies that remain in a woman's blood for years after giving birth may play a role in some diseases, particularly those that first develop or get worse after pregnancy.²

We also know that many immune cells have receptors for sex hormones, says Dr. Whitacre. When hormones bind, or attach, to these immune cells, they can affect the cell's behavior. In fact, women tend to have a stronger inflammatory immune response than men, and inflammation is a key component of many autoimmune diseases.²

"So it's that very close relationship with hormones that provides a clue that they play a big role in autoimmune diseases," says Dr. Whitacre.

Regardless of cause, what is undeniable is that significant numbers of men also face enormous challenges as a result of their autoimmune diseases.

How many? According to the American Diabetes Association, of the 23.5 million people who have diabetes, now thought to have an autoimmune cause, 12 million are men. The National Digestive Diseases Information Clearinghouse estimated in 2001, 408 cases of ulcerative colitis and Crohn's disease occurred per 100,000 people in the United States, approximately half of which were men. These numbers reflect only two AI diseases, and only in the United States, just a small sliver of the world's population.

So even though women do largely outnumber men in most other areas of autoimmune disease, the fact remains that men do experience all AIs, which should be a reminder to us all: Everyone struggling with these difficult diseases deserves support, education, and the right to be treated with dignity.

Got that girls?

Now be nice. To everyone.