Diagnosing and Treating the Predominantly Female Problems of Systemic Autoimmune Diseases

Autoimmune diseases with rheumatic manifestations are predominantly diseases of women. Any woman with new onset arthralgia or arthritis should have a thorough history and physical to rule out autoimmune connective-tissue disease. Screening serologic tests, however, are not necessarily recommended because of high false-positive rates. Serologic tests are most useful in confirming or ruling out the diagnosis; for example, systemic lupus erythematosus (SLE) is rarely present when antinuclear antibodies (ANAs) are absent; the absence of rheumatoid factor will not rule out rheumatoid arthritis (RA), but its presence confirms it. Most autoantibodies (RF [rheumatoid factor], ANA, ENA [extractable nuclear antigen], anti-Jo-1, etc) do not vary with disease flare-ups and remissions. Plain radiographs of the joints are not useful except as a baseline and in detecting erosion at end of long bones associated with RA. Polymyalgia rheumatica and RA, with an incidence of 1 in 2000 to 3000, are the most common autoimmune disorders. Other autoimmune diseases such as SLE, vasculitis, polymyositis, and dermatomyositis are seen infrequently in general practice. Pregnancy, menopause, or breast implantation may affect disease prognosis and treatment. For example, in pregnancy, RA symptoms generally improve, whereas those of SLE may worsen; both diseases may flare postpartum. Oral contraceptives have been associated with an increase in disease flare-ups, but there is little or no evidence that estrogen in the dose level used for replacement is harmful to SLE patients. Although relatively rare, autoimmune diseases can be devastating to the patient if not promptly recognized and properly treated.