Collagen disease: the enemy within

Surprisingly, the autoimmune diseases predominate in women of childbearing years. Recent evidence suggests that these diseases are the result of some interaction of the hypothalamic-gonadal axis with the immune system. The median age for rheumatoid arthritis is 45 years, the median age for lupus erythematosus is 25. Other illnesses, which are autoimmune in character, such as Sjögren syndrome, scleroderma and the vasculitides, are also more commonly found in women. There is no link that ties these illnesses together, except for gender and various disparate immune manifestations such as autoantibodies. The etiopathogenesis of these diseases is reviewed. These diseases are notoriously difficult to diagnose; they mimic other illnesses in their early presentations. Accompanying illnesses such as migraine headaches, Hashimoto's thyroiditis, and fibromyalgia are discussed as related entities. Immunosuppression of diseases like rheumatoid arthritis and lupus erythematosus, is discussed. Various methods of management are considered, such as the use of steroids, cytotoxic agents, and new experimental agents, such as DHEA and IVIG.