This is how it was for Ann, a lawyer from San Francisco. At the age of 32, she described her symptoms to her doctor. She was tired all the time, lost weight without trying and just didn't feel healthy. Her doctor shrugged off her complaints and told Ann she just needed to relax more and maybe take a holiday.

When Ann's symptoms got worse, she didn't go back to her doctor. Instead, she went to a doctor recommended by a friend and was found to have Lupus, an autoimmune disease. Now that the cause of her symptoms were finally discovered, she was able to begin a treatment plan that helped control the symptoms that were upsetting her life.

Difficulty Getting Diagnosed

The term autoimmune disease includes more than 80 different, serious chronic illnesses. Many of these illnesses are rare, but as a group, autoimmune disease troubles millions of Americans - about one adult in every 20.

Ann is not by her self in her experience. Due, in part, to the nature of the symptoms (they are vague, tend to come and go, and are often hard to describe) many patients just get labeled as frequent complainers. In 1997, the American Autoimmune Related Disease Association (AARDA) found that more than 65% of patients with autoimmune diseases had been labeled chronic complainers during the earlier stages of their illnesses. Often doctors find it easy to disregard the complaint since autoimmune diseases tend to strike women during their childbearing years, typically when a woman looks healthy.

Although it is often difficult to get a correct diagnosis in the beginning stages, it is imperative to do so. The ability to quickly identify an autoimmune disease can decrease both physical and mental stress that accompanies a non-diagnosis or incorrect diagnosis.

Why Are Women the Target?

Autoimmune diseases are the fourth leading cause of women's disability among U.S. women, and women make up 75% of patients with autoimmune diseases.

Researchers don't know the answer. Very little is actually know about the causes of autoimmune diseases. Researchers speculate that hormones play a role. It has been theorized that hormones are involved because the expression of autoimmune diseases and their symptoms seems to be related to changes in hormone levels.

"No study clearly states that hormones cause autoimmune diseases," says Virginia Ladd, founder and president of the AARDA, "but a connection between the two is evident. If you look at the number of diagnoses after puberty and before menopause, you see a much higher rate than before or after these events. Also, some diseases suddenly improve during pregnancy, with symptoms re-emerging after delivery, and others may get worse with pregnancy."

Dr. Ladd further explains, "The research is in its infancy, and although the interrelationship between hormones and autoimmune diseases is acknowledged, most aspects of this relationship are not clearly understood."

Looking for a Cause

The purpose of the immune system is to protect the body's vitality by fighting foreign invaders. The primary protectors deployed in the war against infection are the white blood cells. They are a diverse group of cells, but lymphocytes account for about 25% of them and play a major role in defending against "invasion."

The immune system can function properly because of its ability to distinguish "self" from "non-self" tissues. It is normal for some lymphocytes to become sensitized against self tissue, but these defective cells are usually suppressed by other lymphocytes. Autoimmune diseases occur when the control process stops functioning, and the immune system reacts to normal, self body tissue as though it is a foreign tissue. The body actually attacks its own tissues and can destroy them, change organ function, or cause abnormal organ growth.

Could There Be a Genetic Connection?

Autoimmune diseases are not genetic diseases, but genetics is involved in the development of the disease. Autoimmune diseases are not caused by a specific gene mutation. Instead, numerous genes are involved and work together to increase a person's susceptibility.

Autoimmune diseases tend to cluster in families. Although, the clusters manifest as different autoimmune diseases: a mother may have Diabetes; a daughter may have Lupus; and a grandmother may have Rheumatoid Arthritis. Each disease is an autoimmune disease, but a distinctively different disease. Each disease is an autoimmune disease, but a distinctively different disease.

Noel Rose, MD, PhD, a professor at Johns Hopkins University and expert in the field of autoimmune diseases, states in a paper presented at an AARDA conference that "genetic components represent something on the order of half of the risks. If you have a genetic predisposition to autoimmunity, you may have two or five times as much chance of developing autoimmunity as someone else."

Are Autoimmune Diseases Caused by the Environment?

Science has not been able to provide complete answers to the connection between autoimmune diseases and environment. There does appear, however, to be agents in the environment that trigger the disease or intensify the symptoms. These agents include:

* Sunlight - intensifies the symptoms of Lupus, but may also bring about the disease

* Silica - may prompt scleroderma

* Iodine - may intensify thyroid disease

* Viral infections - may trigger or intensify certain immune diseases

* Stress and anxiety - have been shown to increase the severity and frequency of some symptoms

The relationship between environmental factors and autoimmune diseases is not clear. Although much remains to be discovered, researchers believe there may be some association between autoimmune diseases and the environment.

Managing Autoimmune Diseases

Treatment of autoimmune diseases focuses on reducing the severity of the symptoms as most autoimmune diseases are chronic and few can be cured. Steroidal or other anti-inflammatory medications may lessen symptoms in some cases.

Severe diseases may require the suppression of the immune system with immunosuppressive medications.

Experts tell us the best strategy is learning to cope with the disease until effective treatment or preventive measures are discovered. Developing coping mechanisms can be challenging and even alarming. You may not only question your own ability to cope but also the ability of those around you.

Two areas on which to focus your coping efforts are provided by the AARDA:

Dealing With Your Health Care Provider - It is important to not be intimidated by the medical profession; your health care specialist is your partner. Ask questions and understand fully your individual condition and treatment plan. Be an active member in the development of your treatment protocol. Never be afraid to ask for a second opinion.

Dealing With Your Emotions - Mentally, you can expect to feel several different emotions, and it may seem like a tidal wave. The way you handle the emotional cascade is personal; discover the way that works for you. It may be helpful to enlist the support of those around you, remembering that you're not alone. In fact, many people find joining a support group quite helpful. And, most importantly, give yourself and your family time to adjust, since chronic illnesses have many ups and downs and can be emotionally draining.