Autoimmune Diseases in Millennial Women: What You Need to Know
Written by Melissa Schenkman, MPH, MSJ
Diana Girnita, MD, PhD, FACR, knows firsthand what it is like to be a patient faced with a chronic condition at a young age.
She was only 10 years old when she was first admitted to the hospital for severe autoimmune liver disease. The experience ignited her fascination in medical research and its value in discovering new treatments for chronic diseases.
Autoimmune disease is one those chronic diseases. At its root is our body’s inexplicable ability to attack our own healthy cells causing everything from pain to inflammation to joint damage, to rashes and hair loss.
There are more than 100 known autoimmune diseases and yet, their specific cause remains unknown. Amongst the many things that we do know though, is that out of all the millions of people living with an autoimmune disease every day, 80% or 4 out of 5 of them are women. The medical research world has begun to shine light on the reasons behind that and like so many around the country living with this common, yet often rare-feeling set of conditions, we are hopeful to learn more.
Like many, Dr. Girnita is further empowered by this scientific research, but she also shares the vision of an accessible and affordable healthcare system that many of my fellow millennials and our friends in Gen Z have, as they navigate their path to living their healthiest lives. Her practice, Rheumatologist OnCall® is the epitome of that level of care, as she takes both a comprehensive and integrative approach to personalized patient care.
Girnita shares with us why she decided to make her idea for a unique healthcare model into reality for providing much-needed treatment for patients living with autoimmune disease, why this disease is far more common in women, how autoimmune disease can present differently in younger age groups, its impact on pregnancy, the power of the plant-based diet, and the four pillars that she teaches hold up our immune system and make a critical difference in our health.
Rheumatologist OnCall
Although 50 million Americans are living with one or more autoimmune diseases, according to the American Autoimmune Related Diseases Association, finding quality and easily-accessible healthcare to treat symptoms let alone getting a proper diagnosis to start with, can be far more difficult than you would think.
Girnita has seen it take patients living in large metropolitan areas four to six months before getting a diagnosis. For people living in more rural areas with less specialists, it takes even longer. She knew there was a better way beyond what our “traditional medical system” has to offer. That way: Rheumatologist OnCall®.
Girnita’s practice, which she created in 2019, serves patients in-person and virtually in California, as well as via telehealth across eight US States.
“I built my practice on an idea to broaden access to a specialty that is so rare,” Girnita said. “My initial idea was to break this geographical barrier to make people get to a specialist in an easier way at the time you need it the most.”
Her unique care model not only improves accessibility geographically, but also aims to transcend traditional care limitations by prioritizing patient time, offering transparent and affordable services, and integrating a holistic approach that addresses not just the disease but also the individual’s lifestyle.
“In the traditional system, patients will spend about 15 minutes at their first appointment with a specialist. Dealing with complex autoimmune diseases, it's not enough,” Girnita said. “I wanted to change that and make care services very affordable and everything transparent because you never know in the traditional system how much it's going to cost you.”
Diana Girnita, MD, PhD, FACR, is the Founder of Rheumatologist OnCall®, a speaker and author. She is double board-certified in rheumatology and internal medicine. She earned her MD and a PhD in immunology at Universitatea de Medicină și Farmacie din Craiova in Romania, where she grew up. She came to the United States as a PhD student and postdoctoral fellow at Harvard University. The following year she accepted a postdoctoral research position at the world-famous University of Pittsburgh’s Starzl Transplantation Institute, home of the world’s first liver transplant.
After missing working with patients, she resumed her clinical training, first completing an internal medicine residency and then graduating from the University of Cincinnati’s rheumatology fellowship program.
Common Autoimmune Diseases in Women
We often have heard how more women commonly develop autoimmune disease than men. Yet, has anyone ever told you why?
Now, you are about to find out. Girnita specifically researched this topic, finding the number one cause is genetic.
“Women have two X chromosomes, not one like men. The X chromosomes have certain genes, we call them human leukocyte antigen genes or HLA, and some of them will increase the predisposition to develop Rheumatoid Arthritis or other types of autoimmune diseases, and having those two chromosome X will increase the risk for mutation and will increase our risk,” Girnita explained.
The second reason: monthly hormonal fluctuations, including changes in estrogen levels.
“Estrogen in different doses and in different receptors can have pro- and anti-inflammatory effects,” Girnita said. “When we are younger apparently that fluctuation will influence our immune system and can increase the risk for developing autoimmune diseases.”
There is also some cutting-edge research Girnita found that females have immune cells with more pro-inflammatory function than males. Even more than that, she found that the testosterone our male partners produce actually has increased anti-inflammatory effects for them.
Her patient population is overwhelmingly women (70%), and Rheumatoid Arthritis is the most common condition she sees. The second most common condition she sees and the most common in her 20, 30, or 40-year-old patients is psoriatic arthritis. Patients with this condition often go for years before learning their diagnosis. She also sees patients with gout, scleroderma, and lupus.
Here is a more-detailed look at the most common conditions Girnita sees in her practice and other autoimmune diseases affecting younger people:
Rheumatoid arthritis
Rheumatoid arthritis, commonly known as RA, is a chronic, autoimmune disease that attacks the lining of the joints on both sides of your body. The pain and inflammation of RA can be experienced in large and small joints. Over time, joint inflammation damages cartilage. The lack of this natural shock absorber can cause joints to become deformed or have bone erosion.
RA can start at any age, but onset commonly begins between ages 30 and 60. Treatments are aimed at preventing long-term consequences by slowing down disease progression and decreasing joint pain, swelling, and inflammation.
Psoriatic arthritis
Like RA, Psoriatic arthritis is an autoimmune inflammatory disease. The difference is that it only occurs in people, who have an autoimmune skin condition called psoriasis. It presents as red, pink, or purple patches of itchy, dry, or scaly skin that commonly form near knees, elbows, and lower back.
Around 30% of people living with psoriasis develop psoriatic arthritis, and for those who do the symptoms experienced in the joints themselves are the same as those experienced in RA—pain and swelling. Typical onset of psoriatic arthritis is between ages 30-50.
Lupus
Lupus is another type of autoimmune disease that signals the immune system to attack different organs and tissues throughout the body. These can include the kidneys, lungs, heart, joints, and skin. Symptoms usually develop slowly and come in alternating waves of having no to mild symptoms and symptoms that affect your daily life. Most often the condition is diagnosed between ages 15-45.
Multiple sclerosis
Multiple sclerosis, known as MS, instructs our immune system to mistakenly attack the myelin sheath covering the nerves of our brain and spinal cord. As a result, the damaged myelin cannot properly send messages out to other parts of our body to make them function the way they should. This can affect functions like movement and vision.
Early signs of MS include vision changes, muscle weakness, and abnormal sensations or numbness that affects one side of the body. The usual age of onset of MS is between 20 and 40 years old.
Manifestations in the Millennial Age Group
There are unique biological factors that contribute to the onset of autoimmune disease in people’s 20s, 30s, and 40s.
For women, especially during this time in our lives, we are expected to bear the brunt of it all. We find ourselves in this constant balancing act of a mix of simultaneously doing a few of the following: building our career, caring for our spouses and children, managing our households and caring for older relatives.
The relentless pressure and chronic stress, lack of sleep, and limited time to focus on our health, can give our bodies the greenlight for developing autoimmune disease.
With our busy, on-the-go lifestyles, it can often be easier for us to dismiss symptoms that might be warning signs of a more serious condition. However, symptoms like extreme fatigue, joint pain, and morning stiffness are not to be dismissed as mere signs of aging or overexertion, Girnita pointed out.
“In the morning, you should rise and shine. You should wake up and be ready to go. But if you have these symptoms happening in the morning, such as extreme fatigue that affects your lifestyle that’s not normal for your age,” Girnita said. “If you have joint pain, morning stiffness, start developing headaches, tingling or numbness in both hands, or both feet, those all are not normal.”
If you have those, she urges you to get checked out. And if the first doctor you see does not give you answers to help manage your symptoms, she encourages younger patients to seek another opinion.
“I always encourage patients to be their own advocate. We are doctors, but we are not perfect. If you feel like there is something going on in your body, you should be your own advocate,” Girnita said.
Little-Known Aspects to be Aware of
The millennial age group can present with autoimmune diseases in unique ways. Here are three key things Girnita shared with us that people can experience as symptoms that are not commonly known:
Losing hair in clumps or on certain areas of your scalp
Night sweats
Low-grade fevers
Pain that does not have a specific cause
While many doctors zero-in on autoimmune disease’s most common symptoms, looking at the whole picture is ingrained in Girnita’s practice philosophy.
“I always say that what you learn in the textbook is good to pass the exam, but it's not always good to treat patients. You always have to remain open minded and to search for solutions for your patients,” Girnita said.
Impact on Conception and Pregnancy
Another aspect unique to millennial-aged patients is the fact that all women are of childbearing age during this time of their lives. So, you might wonder: How does living with an autoimmune disease affect pregnancy and fertility in general?
There is a lot of misinformation out there, Girnita told us. The truth and good news that she shared is that autoimmune diseases will not impact your ability to conceive. However, planning ahead is key.
“It is very important to understand that if you have an autoimmune disease that is active with a lot of flare-ups, you have to control the disease first, and then you can have a baby. If you don't feel well, you are not able to take care of the baby. So, that's number one,” Girnita explained. “Number two: There are medications that we use for controlling the disease that are not compatible with pregnancy. So, we have to prepare you to switch medication and make sure that you don't have an active disease when you want to conceive.”
She also points out that during pregnancy the immune system quiets down but can flare-up again after delivery. Also, for patients who have lupus, for example, can have antiphospholipid antibodies that could impact their ability to sustain a pregnancy.
All of this is why close communication between you, your rheumatologist and your OBGYN is critical to ensure a healthy pregnancy.
Role of Plant-Based Diet
Along those same lines of planning ahead is the idea of thinking intentionally about what goes into our daily meals.
As it turns out, the plant-based diet beloved by millions of millennials plays a significant role in the prevention of autoimmune disease and quality of life after a diagnosis.
“Your generation is way ahead other generations; I have to tell them. You are very proactive, and you are looking to prevent chronic diseases, which is very important for autoimmune disease,” Girnita said. “There is a lot of research about the plant-based diet that it does decrease your risk to develop autoimmune diseases and that even if you are diagnosed, it will decrease the burden of disease on your life and the way you feel overall.”
Her research supports the potential of dietary choices to reduce disease flare-ups and the amount of medication needed to manage symptoms. She urges those who are diagnosed to consider the power of nutrition in their treatment plans.
“People who eat plant-based diets need less medication. Some of them need very minimal to none,” Girnita said. “I don't want to fool people telling them that you don't need any medication because you might need a little bit, but it's a difference between needing medication in a low dose or three medications in high doses. So, your risk for developing side effects is definitely much higher with more medication than was less medication.”
Lifestyle Adjustments for Prevention
Given the complexity of autoimmune diseases, Girnita focuses on incorporating an additional three other lifestyle factors into her patients’ treatment plans. Each can play a pivotal role in preventing immune system dysfunction and quality of life after diagnosis.
“When I built my approach for my practice for my patients, I thought about the four pillars of prevention—diet, exercise, stress management, and sleep,” Girnita said.
As many of us well know, those four aspects of health can be a daily struggle to obtain in the healthiest way for women, especially those of us in the busiest season of our lives—millennials and Generation Z. But they could not be more important for our health, as they have direct impacts on autoimmune disease often beginning in our 20s, 30s, or 40s.
Exercise improves our immune system’s ability to fight infections and the stability of our joints, Girnita shared. There is a misconception out there that it damages joints if you have Rheumatoid Arthritis or psoriatic arthritis. She wants people to know, it does not damage them, but rather improves joint function.
Stress is also an important risk factor in autoimmune disease. “The more stressed you are, the more flare-ups and disease you are going to have,” Girnita said. She teaches her patients about that cycle and how to minimize their stress through breathing techniques, meditation, and other resources.
Lastly, but not least, there is sleep. “A lot of people, especially in the millennial age group praise themselves that they sleep five hours. Unfortunately, the less you sleep the more the risk for your immune system to activate to become or cross the line towards autoimmunity,” Girnita said. “Even when you have an autoimmune disease, less sleep translates into more pain, which translates into less sleep, creating a vicious cycle that will cause you more pain and less control of your disease.”
She designed a Rheumatoid Arthritis gratitude journal for patients with a section dedicated to keeping track of how much they exercise and sleep along with their symptoms and pain level. Her patients have expressed gratitude for the journal as because of it they “finally understand their journey.”
“They understand that it is not about the disease, it’s about the person,” Girnita said. “This is a journey. The disease you have does not characterize you. You are person and you remain a person.”
And her four pillars of prevention are keys to maintaining that person.
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