The Autoimmune Connection: Essential Information for Women on Diagnosis, Treatment, and Getting On With Your Life Read Free Page A

Center
    Washington, DC
    Jasvinder A. Singh, MD, MPH
    Professor of Medicine
    University of Alabama, Birmingham
    Daniel W. Skupski, MD
    Associate Professor of Obstetrics and Gynecology
    Weill Medical College of Cornell University
    New York, NY
    Virginia D. Steen, MD
    Professor of Medicine
    Division of Rheumatology, Allergy and Immunology
    Georgetown University
    Washington, DC
    David A. Sullivan, PhD
    Senior Scientist, Schepens Eye Research Institute
    Associate Professor, Department of Ophthalmology
    Harvard Medical School
    Cambridge, MA
    Rhonda Voskuhl, MD
    Professor, UCLA Department of Neurology
    Jack H. Skirball Chair for Multiple Sclerosis
    Director, UCLA Multiple Sclerosis Program
    University of California, Los Angeles
    Yusuf Yazici, MD
    Assistant Professor of Medicine
    New York University School of Medicine
    NYU Hospital for Joint Diseases
    New York, NY

Introduction
A New View of Autoimmunity
    I t is a great pleasure for me to welcome the revised and updated edition of the very first book on autoimmune diseases written for a general audience. Since the first edition was published, patients and their families have eagerly awaited news of the latest advances in the field. Many physicians are now using this book for reference in their practices.
    Considered separately, most of the autoimmune diseases are relatively uncommon. But collectively, this group of related disorders actually represents the third most common category of disease in the United States. Many of these diseases start at a relatively young age and have a disproportionate effect on well-being. Patients usually require a lifetime of care because autoimmune diseases are currently incurable. Moreover, the diseases often have great impact on families, particularly if the patient is a young wife and mother. There are, therefore, many societal reasons for considering the autoimmune diseases a major public health problem. One of the unique features of this book is to discuss the impact of these diseases on the various stages of a woman’s life.
    It is only relatively recently that we have begun to think of autoimmune diseases as a single category, much as we think of cancer or cardiovascular diseases—different manifestations of an underlying problem. Because they are regarded separately, autoimmune diseases are typically seen and treated by different medical specialists, and it has not been the mindset of either doctors or their patients to begin to think of these diseases together. Yet there are important reasons to do so.
    One of the common features of autoimmune diseases is a bias toward women. This observation emphasizes the important interrelationship between the hormonal system and immune responses. The fact that there are a few autoimmune diseases that are not more common among women may provide valuable clues that the problem actually began before puberty. This bookoutlines some of the latest theories as to why there is a female preponderance in autoimmunity.
    Clinically, these diseases also travel together. A single patient may have more than one autoimmune disorder. This is quite common and important for patients and their physicians to know. Autoimmune diseases also cluster in families. And while that is an indication that genetics are involved, environment must also play a role.
    When we study genetics, we compare twins who are genetically identical with those who are nonidentical. If a disease is caused by an environmental factor, there should be no difference between identical twins and nonidentical twins since, theoretically, both would be exposed to the same factor or factors. If there is such a difference, it suggests that genetics plays a role. In studies of the autoimmune diseases, we have found that for identical twins the chances of the second twin developing an autoimmune disease are about 30 percent, as opposed to 4 or 5 percent among nonidentical twins. This also tells us that even in identical twins, where genes are the same, the immune