Why more women than men get autoimmune diseases? 80% vs. 20%. (3)

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Women have a survival advantage in many diseases. But 80% of autoimmune problems, such as rheumatoid arthritis, lupus, and multiple sclerosis (one of your particular areas of research) happen more in women. 80% is a big number. You are a leading immunologist studying sex differences in immune system function. What could explain a difference in autoimmune diseases between men and women? You are absolutely right. What we suspect might be the reason is just that more robust immune response exists in women. So with many of autoimmune diseases there’s some sort of persistent inflammation. If you think that women tend to have a more robust inflammatory response, then perhaps they’re more likely to be susceptible to that persistent inflammation. More so because we know that estrogen will influence the inflammatory response. So females might be predisposed by virtue of their estrogen levels. Females have very robust immune response which isn’t turned off during autoimmune diseases. If you look at something like rheumatoid arthritis, where the prevalence is much higher in women compared to men. Women who become pregnant then go into remission. We know that’s a consequence of changes in hormonal levels. So during pregnancy their rheumatoid arthritis will go into remission. Immediately after they deliver a baby, women very often have a new flare of rheumatoid arthritis. So estrogen plays a critical role in activating those immune cells which might drive that persistent inflammation. So in the diseases such as rheumatoid arthritis, do women have anti-estrogen therapies? There’s a lot of hormone-related therapies for various other diseases including diseases in gynecology. How does hormonal therapy affect treatment of autoimmune diseases? I’m sorry to say that nothing is ever simple. Just you find one target, and – presto – everything disappears. We’ve seen that with various therapies against autoimmune diseases. There is biological therapies certainly. Biologics contribute to reducing the autoimmune disease. But anti-estrogen therapy is not going to put somebody with autoimmune disease into remission.