Women get sick more often, and many are still not heard
Over the years of clinical practice, I understood that a patient's medical record is just the starting point of a much more complex reality. This is how I got closer to listening than to certainty, because, in the office, what is presented are not just symptoms, but stories that exams cannot fully capture.
Why autoimmune diseases affect more women
When we observe that around 80% of diagnoses of autoimmune diseases in the world belong to women, this data indicates a relevant health problem, still little addressed in due depth. Autoimmune diseases are those in which the immune system is dysregulated and attacks the body's own cells. There is a wide range of autoimmune diseases that can affect various tissues and organs.
This difference appears even more evident when we look at specific pathologies. In the case of systemic lupus erythematosus, the proportion reaches nine women for every man. A similar pattern is seen in primary biliary cholangitis and Sjögren's disease, both also with a ratio of 9 to 1. At an intermediate level, scleroderma affects about six women for every man. Thyroid diseases, such as Hashimoto's thyroiditis, and rheumatoid arthritis have ratios of five to one and four to one, respectively.
Therefore, in addition to interpreting laboratory markers, clinical work requires recognizing that, behind each result, there is a woman trying to sustain her routine, her plans and her identity.
What biology explains and what it cannot explain on its own
Science shows us that the female immune system is, by definition, more reactive. Genetically, the presence of two X chromosomes creates a greater density of genes responsible for regulating immunity. Although the organism tries to balance this "double dose" by inactivating one of the X chromosomes in most cells, what often occurs is a state of excessive readiness. Added to this, estrogen acts as fuel for defense cells.
This characteristic is not a "defect", but rather an evolutionary legacy. Historically, this "immunological hyperactivity" was what allowed women to survive moments of extreme vulnerability, such as births and major infections in precarious contexts. What happens today is that this same force, which protected the species for millennia, can turn against the organism itself in an environment of stress and genetic predisposition.
When symptoms do not fit into examinations
In clinical practice, it is common for autoimmune diseases to begin silently, with diffuse and non-specific symptoms: persistent fatigue, joint pain, skin lesions, excessive hair loss, changes that are not immediately organized into a clear diagnostic picture. This often leads to a prolonged journey until the disease is confirmed.
Technology has expanded our diagnostic capacity. Today, we are able to identify autoantibodies even before clinical symptoms appear, which represents an important advance. However, not every asymptomatic individual carrying autoantibodies will necessarily develop an autoimmune disease. Digital tools and decision support systems also contribute to data analysis and patient monitoring. However, the key is to integrate laboratory findings with a detailed clinical assessment.
Therefore, expanding care also involves understanding the context in which these diseases develop. Psychological stress, for example, is a recognized factor in activating crises in diseases such as lupus and rheumatoid arthritis. This stress does not occur in isolation. It is associated with living conditions, overload of responsibilities and social pressures that directly impact health.
The body responds to these conditions in an integrated way. Therefore, areas such as sociology and psychology contribute concretely to clinical practice. They help to understand factors that influence the course of the disease and that do not appear in laboratory tests. Therefore, it is important to integrate different dimensions of the patient experience. This includes drug treatment, ongoing monitoring, guidance on lifestyle habits and, above all, qualified listening.
Living with an autoimmune disease requires constant adjustments. With adequate monitoring, many patients are able to maintain their personal and professional plans, but this depends on continuous and individualized care.
Health, in these cases, cannot be understood simply as the absence of disease. It begins to involve the ability to sustain a possible life, with access to care, clinical stability and recognition of one's own limitations, without this meaning giving up projects and identity.
*Text written by Luís Eduardo Coelho Andrade, rheumatologist and medical advisor in the Immunology area of Grupo Fleury (CRM/SP 38661 | RQE 10570)
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Source: CNN