AUTOIMMUNE DISEASES

The following information is to be used as a guide and at the discretion of the end-user and should not replace a doctor’s opinion.

OVERVIEW

Autoimmune diseases are a significant and growing health concern, affecting millions of people worldwide and disproportionately affecting women – over three-quarters of all autoimmune disease patients are women due to hormonal, genetic, and immune-system factors.

Autoimmune diseases are chronic conditions caused by your body’s own immune system mistakenly targeting your own healthy cells, tissues, or organs rather than defending against foreign threats like bacteria or viruses. They arise when your immune system starts treating “self” antigens — the normal components of your body — as a danger and begins attacking them. This can lead to chronic inflammation and damage in the affected organs.

There are more than 80–100 distinct autoimmune diseases, such as rheumatoid arthritis, systemic lupus erythematosus (lupus), multiple sclerosis, Sjögren’s syndrome, and autoimmune thyroid disorders.

These conditions are often chronic and require long-term management to reduce symptoms and prevent damage to organs or tissues. While these diseases cannot yet be cured, early diagnosis and treatment can significantly improve outcomes.

AUTOIMMUNE DISEASE IN SOUTH AFRICA

Accurate, nationwide prevalence data for autoimmune diseases in South Africa are limited, largely because population-based surveillance is sparse and many cases go undiagnosed. However, there is research showing:

Systemic lupus erythematosus (SLE): SLE causes multisystem inflammation and more severe disease progression has been noted in individuals of African descent. Higher fatality rates have been reported in sub-Saharan settings. There is an estimated 1.7% prevalence in sub-Saharan Africa, and the disease is thought to be most common in young women of African descent.
Autoimmune hepatitis (AIH): AIH causes liver inflammation and is a disease most commonly affecting young women. AIH is older women is more commonly seen in HIV positive patients.
Thyroid Autoimmunity (e.g. Hashimoto’s): This autoimmune disease of the thyroid has a global prevalence of 7.5%, and varies greatly by region, with the highest rate in Africa. Globally it is more common in women.

Hashimoto’s thyroiditis

The thyroid gland becomes inflamed, impairing its ability to produce thyroid hormones. This leads to a gradual decline in function and eventually an underactive thyroid, which causes many functions of the body to slow down. Symptoms include fatigue, weight gain, constipation, dry skin, hair loss, and cold intolerance. It is 4–10 times more common in women, typically arising between ages 30–50.
Psoriasis
Type-1 diabetes (T1D)

Also known as juvenile diabetes or insulin-dependent diabetes, T1D occurs when the body’s immune system attacks insulin-producing pancreatic cells, causing the body to have insufficient insulin stores. These insufficient insulin levels hinder glucose from entering cells, negatively impairing the energy production process in the body. T1D requires lifelong management through blood sugar monitoring, insulin injections or pumps, and lifestyle adjustments.
Rheumatoid arthritis (RA)

RA causes chronic joint inflammation and disability. Diagnosis is typically between ages 30 and 60. It causes painful inflammation in joint linings (fingers, wrists, ankles), leading to potential deformity if untreated. Women are affected 2-3 times more often than men.
Multiple sclerosis (MS)

MS causes immune attacks on the axons and myelin in the central nervous system that cover nerve fibres, which causes permanent communication problems between your brain and the rest of your body. It is about three times more common in women than men and typically diagnosed between ages 20 and 40. Women often experience more severe fatigue, pain, and, in some cases, symptoms that fluctuate with hormonal changes like menstruation, pregnancy, or menopause. Common symptoms include vision loss, numbness, weakness, and bladder issues.
Systemic lupus erythematosus (SLE)

SLE is the most common form of lupus in which the immune system attacks its own healthy tissues resulting in widespread inflammation and tissue damage of joints, skin, brain, lungs, kidneys, and blood vessels. Women are 8-10 times more likely to be diagnosed than men. It is more prevalent and often more severe in individuals of African and mixed ancestry; particularly young women aged between 15-40. Diagnosis requires prompt medical attention, especially in children, and management often involves a combination of treatments, including antimalarials and corticosteroids.
Sjögren’s disease (SjD)

SjD causes the immune system to attack the body’s moisture-producing glands. The condition most often affects the salivary and lacrimal glands, leading to common symptoms such as dry mouth and dry eyes. SjD affects women much more frequently than men and is usually diagnosed in people over 40.
Celiac disease

Celiac disease causes damage to the small intestine in response to gluten consumption. Gluten is a protein found in wheat, barley, and rye products. Over time the damage to the small intestine’s lining often causes systemic symptoms and damage. Sometimes an individual experiences no symptoms, which is known as asymptomatic celiac disease. Celiac disease occurs 2–2.5 times more frequently in women than men. Treatment requires a strict, lifelong gluten-free diet to manage symptoms and avoid long-term risks like osteoporosis.
Vitiligo

Vitiligo is a skin disease that occurs when autoantibodies attack melanocytes (the skin cells that produce melanin or the chemical that produces skin colour). There are two main types of vitiligo: non-segmental (symmetrical white patches on both sides of the body) and segmental (affects just one area of the body). There are also several subtypes. Vitiligo affects both men and women equally, regardless of race or skin colour, and is found in around 1% – 2% of the global population.

WHAT TRIGGERS AUTOIMMUNE DISEASE?

No single cause fully explains autoimmune diseases, but most scientists agree that they arise from a complex interplay of genetic predisposition and environmental triggers:

Infections and molecular mimicry
Environmental and lifestyle factors

Smoking, air pollution, diet, stress, sleep disruption, and gut microbiome imbalances are all implicated as triggers that can tip genetic susceptibility toward disease. These factors may collectively stimulate the immune system in ways that lead to self-reactivity.
Hormonal shifts
Other influences

WHY ARE WOMEN DISPROPORTIONALLY AFFECTED?

Autoimmune diseases occur more often in women than in men — by a wide margin – and scientific evidence points to several contributing biological and environmental factors:

Sex hormones
Genetic and chromosomal factors

Women carry two X chromosomes, and genes on the X chromosome are involved in immune system regulation. Some immune-related genes may escape normal X inactivation, leading to higher expression levels in women and possibly increasing susceptibility to autoimmune dysregulation.
Immune response differences
Microchimerism

During pregnancy, foetal cells transfer to the mother (and vice versa) through the placenta. These cells can persist in a mother’s tissues – even in organs like the brain, heart, and liver – for decades after pregnancy, which may trigger an immune response.

HOW ARE AUTOIMMUNE DISEASES DIAGNOSED?

Autoimmune diseases are challenging to diagnose because symptoms like fatigue, joint pain, and fever often overlap with other conditions. Diagnosis generally involves:

Comprehensive history and physical examination
Laboratory testing for autoantibodies and inflammatory markers
Imaging studies (e.g., X-rays, MRI) depending on the organ system involved

Because autoimmune diseases can mimic other illnesses, delays in diagnosis are common, particularly in resource-limited settings like parts of South Africa where specialists may be scarce.

TREATMENT AND MANAGEMENT

Standard medical approaches
There are no known cures for most autoimmune diseases, but many can be managed effectively with modern medical treatments, including:

Immunosuppressive drugs (e.g. corticosteroids, methotrexate) to lower immune responses

Biologic therapies targeting specific immune pathways (e.g. TNF inhibitors, B-cell depleting agents)

Symptom control and supportive care (e.g. pain relief, physical therapy, treatment of organ-specific complications)

These treatments aim to reduce inflammation, control disease activity, and preserve quality of life. Treatment is individualised based on disease type, severity, organ involvement, and patient factors.
Emerging research

Cutting-edge research aims to develop precision therapies that modulate immune tolerance more specifically — such as targeted biologics and personalised medicine approaches — although these are still in early stages and are not universally available. They can also be prohibitively expensive.
Holistic and supportive care
Because autoimmune diseases often affect quality of life and can be associated with chronic pain, fatigue, and mental health conditions, comprehensive care may include:

Nutritional and lifestyle interventions

Psychological support and screening for depression or anxiety

Rehabilitation and exercise programmes

Chronic autoimmune disease is linked with higher rates of depression and anxiety, especially in women — partly due to chronic inflammation and the severe impact of symptoms on quality of life — making mental health support essential.

AUTOIMMUNE DISEASES

AUTOIMMUNE DISEASES

The following information is to be used as a guide and at the discretion of the end-user and should not replace a doctor’s opinion.

OVERVIEW

AUTOIMMUNE DISEASE IN SOUTH AFRICA

THE MAIN TYPES OF AUTOIMMUNE DISEASES

WHAT TRIGGERS AUTOIMMUNE DISEASE?

WHY ARE WOMEN DISPROPORTIONALLY AFFECTED?

HOW ARE AUTOIMMUNE DISEASES DIAGNOSED?

TREATMENT AND MANAGEMENT

FURTHER READING