Autoimmune Diseases More Common in Women Benefit from Topical Compounded Treatments
Are you looking to target counseling efforts to reach the patients who will benefit the most from your expertise? Perhaps it would be helpful to consider women with skin conditions, fatigue and general joint or muscle pain. These symptoms might point to conditions like fibromyalgia and chronic fatigue, but they are also hallmarks of autoimmune diseases. Since a significantly larger number of women develop autoimmune disease than men, it’s worth talking with these women about their diagnoses and the topical compounded treatments that will improve their health and boost their quality of life.
Top Autoimmune Diseases in Women
With at least 80 distinct diagnoses affecting virtually every part of the body, it’s clear that autoimmune diseases are complex and often difficult to diagnose. The diverse manifestations aren’t the only confounding factors. While the tendency to develop autoimmune disorders is inherited, disease is triggered by any number of environmental factors. And in spite of its genetic component, members of the same family can be diagnosed with different autoimmune conditions. Yet many autoimmune diseases share one common characteristic: they affect more women than men. About 75 percent of the 24 million Americans with autoimmune disease are women.1
Many patients don’t realize that well-known health conditions such as rheumatoid arthritis, fibromyalgia, multiple sclerosis and irritable bowel syndrome are autoimmune diseases. Women are nearly three times more likely to have rheumatoid arthritis and they have double the chance of developing the other three conditions compared to men, but none of these illnesses are in the top five autoimmune disorders more prevalent in women. The top five by ratio of women to men are:2
- Hashimoto’s disease – 10:1 – Hashimoto’s, or autoimmune thyroiditis, is characterized by infiltration of the thyroid gland with lymphocytes, antibody-producing B cells and macrophages. Thyroid follicles are progressively destroyed, resulting in necrosis, fibrosis and hypothyroidism.
- Systemic lupus erythematosus – 9:1 – Multisystem inflammatory disorder with production of antibodies to components of the cell nucleus. SLE is associated with estrogen, which boosts autoantibody production and elevates levels of immunoglobulins. After menopause, the female to male ratio drops to 2:1.
- Sjogren syndrome – 9:1 – Immune system disorder that primarily attacks glands that produce tears and saliva, leading to dry eye and dry mouth. It may also damage organs and tissues, causing inflammation of connective tissues, joints and muscles.
- Autoimmune hepatitis – 8:1 – A disease characterized by hypergammaglobulinemia and necroinflammatory activity that’s classified according to autoantibody profiles. About 80 percent of cases are type 1, which starts in adolescence or young adulthood, while type 2 occurs in childhood. Patients with either type often have other autoimmune disorders.
- Graves disease – 7:1 – Immune system produces antibodies that activate thyrotropin receptors, which increases synthesis of thyroid hormone. The disorder may progress to affect organs. During the first year of treatment, 90 percent of patients swing to hypothyroidism. Nearly a third of patients develop Graves’ ophthalmopathy.
Causes of Sex Bias: The precise mechanisms and their varied roles in different autoimmune conditions have yet to be precisely defined, but it’s clear that sex hormones and genetics are two reasons why women are disproportionately affected. Sex hormones act upon neutrophils, B cells, T cells, monocytes and murine NK cells to affect the immune response.3 The X chromosome has about 1,000 genes that are not encoded on the Y chromosome and about 70 percent of them are associated with diseases. Studies have verified that the XX chromosome makes lab mice more susceptible to autoimmune disease compared with the XY chromosome.4
It’s important to distinguish drug-induced lupus erythematosus, which affects men and women equally and is estimated to account for 10 percent of systemic lupus erythematosus diagnoses. More than 90 medications in 10 drug classes have been associated with drug-induced lupus erythematosus, but those that are definitely implicated include:5
- Procainamide: 15 to 20 percent risk
- Hydralazine: 7 to 13 percent risk
- Quinidine: moderate risk
Benefits of Compounded Topical Treatments
While autoimmune diseases are generally treated with immunosuppressants and corticosteroids, treatment must always be determined by the underlying disease. Some pharmaceutical choices are straightforward; for example, Hashimoto’s patients need thyroid hormone replacement, while those with Graves’ disease are initially treated with radioactive iodine for hyperthyroidism. Other medical decisions and treatment options are complicated by the involvement of the heart, liver, lungs and other vital systems. Regardless of the complexities, many autoimmune disorders, including those most commonly found in women, share symptoms that benefit from compounded treatments:
Dermatological: Women with autoimmune disorders often have dry skin, skin rashes and pruritus. Depending on the severity of their condition, they may simply try OTC products, but there’s a good chance they’ll see better results with compounded treatments, so talk to them about:
- Emollient bases that protect the skin barrier while delivering the active ingredients most appropriate for their condition.
- Topical steroids formulated in more effective doses than OTC products.
Musculoskeletal: Arthritis, arthralgia and myalgia develop in many autoimmune disorders. Compounded topical pain relief may be the key to helping women maintain their normal activity level. These patients benefit from:
- Topical NSAIDs such as diclofenac sodium that provide effective pain relief without the worry of side effects.
- Capsaicin or a mixture of capsaicin, methyl salicylate and menthol can be recommended for patients who prefer to try natural products before switching to pharmaceuticals.
- Glucosamine and chondroitin are proven to improve joint pain and may help slow down cartilage degeneration in autoimmune patients with arthritis.
Fatigue: Fatigue is a potential symptom across the range of autoimmune diseases. Custom compounding is especially appropriate for tackling fatigue because you can formulate medications to treat multiple contributing factors, including:
- Difficulty sleeping improves with natural products such as melatonin
- Hormonal imbalances
- Antidepressants to relieve pain and depression
Solutions from Compounding Pharmacists Can Make a Difference
Many women aren’t aware of the advantages of compounded topical treatments, so don’t hesitate to reach out to discuss options. When you talk with them, make a medication management appointment because they’re likely to take multiple prescription and OTC products. As you review medications, take the opportunity to suggest combining several medications into a single dose. Women with autoimmune disorders already have enough to worry about; your compounded solutions can make their lives easier and improve their health.
Pharmaceutica North America provides bulk APIs, OTC supplements and custom compounding kits that support the health needs of your patients with autoimmune diseases. Contact us today to learn about our diverse line of high-quality pharmaceuticals.
- “Autoimmune Diseases Fact Sheet,” July 2012, http://womenshealth.gov/publications/our-publications/fact-sheet/autoimmune-diseases.html ↩
- “Sex Differences in Autoimmune Disease From a Pathological perspective,” September 2008, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2527069/ ↩
- “Genetic and Hormonal Factors in Female-Biased Autoimmunity,” February 2010, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3171140/ ↩
- “A Role for Sex Chromosome Complement in the Female Bias in Autoimmune Disease,” May 2008, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2373842/ ↩
- “Drug-Induced Auto-Immune Diseases,” January 2016, http://www.pharmacytimes.com/publications/issue/2016/january2016/drug-induced-autoimmune-diseases ↩