Winter, pollution, changing lifestyle surging autoimmune diseases in women

The burden of autoimmune diseases is steadily rising, particularly among women, and the winter months — compounded by high levels of air pollution — may be intensifying symptoms, a senior expert from AIIMS Delhi warned on Wednesday.

Dr Uma Kumar, professor and head of the department of Rheumatology at the All India Institute of Medical Sciences, said autoimmune disorders arise from a complex interplay of genetic, hormonal, environmental and lifestyle factors, and can affect either a single organ or multiple systems of the body.

While organ-specific conditions may involve just one part of the body, such as the pancreas, systemic autoimmune diseases can impact several organs simultaneously. These include rheumatoid arthritis, systemic lupus erythematosus, scleroderma, Sjögren’s syndrome and IgG4-related diseases, among nearly 60 recognised conditions. Women, she noted, bear a disproportionate share of this burden.

“These diseases can strike at any age but are far more common in women of reproductive age,” Dr Kumar said. “Female hormones and immune-related genes on the X chromosome play a crucial role. The female-to-male ratio is highest in adolescence and young adulthood and gradually equalises after menopause.”

She explained that the ratio can be as high as 9:1 in younger women, eventually narrowing to nearly 1:1 among those aged 60 to 70 and above.

Dr Kumar also drew attention to the social stigma surrounding autoimmune diseases, particularly for women. “Many women are neglected because of misconceptions that these conditions are hereditary or contagious, which is simply not true. As a result, they often suffer in silence, with profound consequences for mental health,” she said.

Winter, she added, brings a convergence of factors that can worsen symptoms — cold temperatures, reduced atmospheric pressure, joint stiffness, limited sunlight leading to vitamin D deficiency, weight gain, low mood, rising pollution levels and a higher incidence of viral infections.

Air pollution, in particular, has emerged as a powerful trigger. Studies have shown elevated inflammatory markers, oxidative stress and even the presence of autoantibodies in otherwise healthy individuals exposed to high pollution, especially those living near busy roads. “This provides compelling evidence of a strong link between air pollution and autoimmune disease risk,” Dr Kumar said.

Chronic psychological stress and disrupted sleep further aggravate inflammation and disease activity, with night-shift workers facing a higher risk. In the post-COVID period, doctors have also observed a noticeable surge in autoimmune and inflammatory conditions, underscoring the role of environmental and lifestyle influences.

Unhealthy diets, smoking, tobacco use and obesity also contribute significantly. Obesity itself, Dr Kumar noted, is a chronic inflammatory state that predisposes individuals to autoimmune conditions.

She added that rising numbers may partly reflect better diagnostic tools and growing awareness among doctors and patients alike. “Since awareness initiatives began over a decade ago, recognition of these diseases has improved considerably,” she said.

Despite their chronic nature, autoimmune diseases are treatable, though they usually require lifelong management, much like diabetes or hypertension.

“There is no single symptom or test that can confirm these conditions,” Dr Kumar cautioned. “Symptoms can range from fatigue, fever and joint pain to skin rashes, hair loss, dry eyes or mouth, kidney or neurological involvement, and even recurrent pregnancy loss. Autoantibodies may also be found in healthy individuals, so indiscriminate testing without medical guidance can be misleading.”

She warned against the unsupervised use of steroids and painkillers, stressing that such medications are not necessary for all autoimmune disorders.

Emphasising the importance of prevention and control, Dr Kumar said lifestyle modification is essential. “Adequate sleep, stress management, regular physical activity, smoking cessation and weight control help reduce disease flares,” she said, adding that yoga has been shown to lower inflammation and improve sleep quality among patients with autoimmune diseases.

With IANS inputs