What Are Rheumatic Diseases?
Rheumatic Disease is a very broad category of diseases that include various conditions that are mainly characterized by ill joint health and its supporting structures. The joint structure may be damaged along with the tendon, ligament, or muscle that is attached to it. Some of the generalized symptoms of rheumatic diseases include joint aches and pains that may range from mild to severe; increased joint stiffness; reduced range of motion; compromised mobility; extreme dependency on others to carry out minor routine tasks like walking or sitting, thus ultimately owing to mental health problems like depression and social anxiety. To add to this, joint health is not the only aspect to be considered. The involvement of other internal organs vital for sustaining life is also one of the major setbacks of rheumatic diseases. Major body systems like the neurological, cardiovascular, and renal may also show clinical manifestations of rheumatic disease. This makes it important for the rheumatologist to keep all other specialists in the loop during the treatment planning of a patient.
Who Is Affected By Rheumatic Diseases?
Rheumatologic Diseases can happen to anyone irrespective of their age or gender. The main causes that potentiates rheumatic disease in one are:
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Family history or genes.
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Immunologic factors.
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Environmental Factors which include personal habits like smoking or chewing tobacco, a sedentary lifestyle, being overweight thus imparting excessive stress on joints.
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Accidents or trauma.
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Certain Infections.
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Metabolic Disorders.
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Overuse of a joint causing mechanical wear and tear thus damaging the structural integrity.
A list of some common rheumatic diseases includes:
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Osteoarthritis: This is a chronic degenerative disorder of the joints that is caused by wearing away the articular cartilage over a fair amount of time. It is most commonly found in older adults.
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Rheumatoid Arthritis: This is one of the most common rheumatic diseases that affects the inner lining of the synovial joint. It is a chronic disease that is triggered by one's autoimmunity (the immune system attacks the healthy cells of the body). Women are more predisposed to this disease compared to men.
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Scleroderma/Systemic Sclerosis: It is a rare, chronic disease that mainly affects the connective tissue of the body. The fibrosis of the internal organs is one of the main features of this disease. Again, it is more commonly found in women.
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Systemic Lupus Erythematosus (SLE): This is another chronic auto-immune disorder that affects women more as compared to men. Black men and women are predominantly affected by this disease relative to whites.
Other common diseases include Vasculitis, Sjogren's Syndrome, Giant Cell Arteritis, Fibromyalgia, and Ankylosing Spondylitis, among many more.
How Do Rheumatic Diseases Impact Women’s Health?
The incidence of rheumatic disease has always been found to be greater in women compared to men, except for a few exceptions like ankylosing spondylitis, where men are more affected than women. Rheumatoid Arthritis, Sjogren's Syndrome, and Systemic Lupus Erythematosus are among those diseases that have a very high predilection to affect women by a greater margin in relation to men.
It is very difficult to give a sure-shot answer as to why women are more prone to rheumatic diseases. Many theories have been proposed that give a suitable explanation for this phenomenon. One such theory states that a woman, being a mother, has the ability to impart the antibodies and immunoglobulins to the offspring postpartum. This demands an extremely strong immune system in the birth-giving mother, thus making it more active- as compared to the male counterpart. This increases its possibility to activate in an abnormal fashion at times (autoimmunity).
Differences in male and female hormones have also been proposed as a reason for such differences in sexes associated with rheumatic diseases. Hormones like estrogen tend to modulate the functioning of the immune system in such a way that it triggers autoimmunity in some women while not having any significant effect on others. The level of estrogen present in a woman's body is proven to change with time, as a woman transitions from childhood to adulthood, goes through pregnancy, and finally, during the post-menopausal years. This increased variation in hormone levels may be held accountable for the prevalence of autoimmune diseases in women. Similarly, hormonal imbalance may also be encountered in women who use contraceptive measures to avoid unwanted pregnancy. The rest of the article reflects on how contraceptive measures can affect women with existing rheumatic disease.
What Are the Different Contraceptive Methods?
The various contraceptive measures adopted by women in today’s world include:
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Periodic Abstinence: This method is quite unreliable owing to its manual nature. The women who opt for this method avoid indulging in any sexual activity during the time of the month that is most favorable for pregnancy. Usually, day 10 to day 17 of the menstrual cycle is the most likely time for a woman to get pregnant. This method is also referred to as natural contraception.
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Barrier Methods: The most common method of contraception utilized by all. It involves wearing external barriers during the time of intercourse, thus preventing any direct physical contact between the involved partners. Examples include condoms, diaphragm, cervical cap.
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Intrauterine Devices (IUDs): These refer to miniature devices that are implanted into the uterus of the female to prevent pregnancy. They are either made out of copper.
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Hormonal Contraception: This involves the usage of either estrogen and progesterone or progestin alone. The main forms of this type include contraceptive pills, hormonal injections, an implant, an IUD that releases progesterone, vaginal rings, and skin patches.
Do Contraceptive Methods Have Any Adverse Effects On A Woman With Rheumatic Disease?
Different rheumatic diseases have varying degrees of effects upon administering contraceptive measures in women. The most common rheumatic diseases found in women are Systemic Lupus Erythematosus, Rheumatoid Arthritis, Vasculitis and Systemic Sclerosis. These are discussed below.
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Systemic Lupus Erythematosus: Patients with a stable SLE disease are reported to have a lower risk of disease flare-ups upon taking oral contraceptives. Hormonal contraception is deemed to be much safer for such patients. However, patients with a very active SLE are advised to opt for barrier methods or progestin-only contraceptives. There is no sufficient data to support the use or disuse of IUDs in SLE patients.
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Rheumatoid Arthritis: The use of oral contraceptives in women with already established Rheumatoid Arthritis has shown to have no increased risk of disease activity. Unlike SLE, the symptoms of rheumatoid arthritis have been observed to improve upon using oral contraceptives. The use of IUD, however, has been contraindicated in certain patients who are active on immunosuppressive therapies.
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Other Autoimmune Diseases: The administration of intravenous estrogen therapy has been shown to be beneficial in patients with systemic sclerosis. On the other hand, there is not enough research done on the effects of estrogen in patients with Vasculitis. Hence, it is not yet advised to be provided in Vasculitis patients or those with a risk of ischemia or atherosclerosis.
Conclusion
The action of contraceptives on women of reproductive age accompanied by rheumatic diseases is one of the top research carried out today. Rheumatologists and gynecologists are actively participating in establishing a reliable source of data to spread more awareness of the effects of contraceptive measures on these women.
