32 year-old Neha Sharma, a marketing executive from Bengaluru, felt relieved when her perpetual fatigue and joint pain were initially diagnosed as stress. But months later, when her fingers began to swell and morning stiffness made even brushing her teeth a painful task, she learned that she had rheumatoid arthritis, an autoimmune disease where the body’s own immune system attacks healthy tissue.
Neha’s story is not a one-off. Across India and the world, autoimmune conditions, diseases in which the immune system mistakenly targets the body itself, are on the rise, particularly among women. At the 40th annual conference of the Indian Rheumatology Association (IRACON 2025) held recently in Delhi, it was revealed that nearly 70% of people living with autoimmune diseases happen to be women.
Health experts in India believe that autoimmune diseases are found to be more common among women than in men. Doctors are diagnosing more and more young women with lupus, rheumatoid arthritis (RA), scleroderma and Sjögren’s syndrome.
A gendered predisposition
“Women are much more vulnerable to autoimmune diseases,” says Dr Bimlesh Dhar Pandey, Director – Rheumatology at Fortis Hospital, Noida. “If we take conditions like rheumatoid arthritis, lupus, or scleroderma, they are many times more common in women than in men. For example, Sjögren’s syndrome is almost nine times more common in women, and rheumatoid arthritis about three times more common.”
The reason, he explains, lies in biology. Women’s immune systems are built differently. “A woman’s life passes through distinct hormonal phases – puberty, menstruation, pregnancy, and menopause. These cyclical hormonal changes influence the immune system and make it more prone to going into overdrive,” he says.
Most autoimmune diseases strike during the reproductive years – the very age when women are most active socially and professionally. “The hormonal changes during pregnancy and post-pregnancy, along with genetic predisposition and environmental triggers like pollution or infections, can all work together to trigger disease onset,” Dr Pandey adds.
The environmental factors
Pollution, diet, and stress – more prounounced than ever are critical triggers in women who are already genetically susceptible to autoimmune disorders.
“There is probably a greater link between environmental factors and autoimmune diseases than we realise,” says Dr Shweta Singhai, Senior Consultant, Rheumatology, Sakra World Hospital, Bengaluru.
She states how air pollution is emerging as a significant risk factor. “Exposure to high levels of smoke and vehicular pollution increases oxidative stress and can cause immune dysregulation. Studies show that people living near busy roads or industrial areas are more prone to autoimmune diseases. Cigarette smoking, too, remains a major trigger for conditions like RA.”
According to her, the gut microbiome, also plays a crucial role. “When healthy bacteria in the gut are altered by excessive consumption of sugary, processed foods, it leads to immune imbalance. The gut and the immune system are deeply connected. An unhealthy gut can misguide immunity to attack the body.”
Other lifestyle contributors include factors like stress, erratic sleep, and a sedentary routine. “Modern work patterns: night shifts, long hours, and irregular sleep affect hormone balance and stress levels. Obesity and vitamin D deficiency, both increasingly common due to indoor living and poor diet, also contribute to autoimmune risk,” emphasises Dr Singhai.
Are autoimmune diseases afflicting younger women?
Doctors observe a concerning shift that these diseases are being diagnosed at younger ages than earlier.
“Autoimmune diseases are now being diagnosed in women in their 20s and 30s, compared to the 40s or 50s a decade ago,” says Dr Singhai. “This partly reflects increased awareness among urban populations, but also shows how lifestyle and environmental triggers are accelerating disease onset.”
Even with better awareness, diagnosis is often delayed. “Many autoimmune conditions in women are mistaken for stress or anxiety,” she notes. “If you take 100 patients with autoimmune diseases, 60–70% will be women. Yet their symptoms – fatigue, pain, hair loss, or low-grade fever, are often brushed aside. Women tend to prioritise family over themselves and seek medical help late.”
She urges women to be alert to red-flag symptoms such as persistent fatigue, joint pain, loss of appetite, prolonged fever, or hair fall that lasts beyond three to six weeks. “These shouldn’t be ignored. Early detection and treatment can prevent permanent organ or joint damage.”
Hormonal therapies and triggers
The influence of hormones doesn’t end with natural cycles. Dr Sapna Raina, Clinical Lead, Obstetrics & Gynaecology, Narayana Health City, Bengaluru, points out that hormonal therapies, too, can influence autoimmune activity.
“For most women, hormonal contraceptives are safe and beneficial. But in those who already have a tendency toward autoimmune conditions, certain hormonal formulations can occasionally influence disease activity,” she says.
“Estrogen-based pills, for instance, may slightly alter immune regulation. This doesn’t mean they directly cause autoimmune diseases, but they might trigger flare-ups in genetically susceptible individuals. The same caution applies to hormone replacement therapy in menopause,” she adds.
Dr Raina stresses the importance of personalization in women’s health. “Every woman’s hormonal and immune profile is unique. That’s why it’s essential to evaluate family history and existing conditions before starting long-term hormonal medication. The goal is to balance reproductive health and immune stability together.”
The combination of genes and environment
Dr Raina notes, “Certain genetic markers like HLA types and X-chromosome variations can predispose women to an overactive immune response. However, stress, infections, diet, and lifestyle often determine when and how these genetic risks manifest. While we cannot change our genes, we can reduce risk through awareness, balanced nutrition, and stress management.”
The silent epidemic
Despite its growing prevalence, autoimmune disease remains underestimated medical condition in the country. “It’s a silent epidemic,” says Dr Pandey. “We are capturing more and more new patients and types of diseases that weren’t diagnosed before. Even if just 1–2% of India’s population is affected, that translates to 28 crore people which is massive.”
What makes the issue even more complex, he says, is the lack of public health data and trained specialists. “For such a large population, we don’t have genuine national data on autoimmune disease incidence or prevalence. We need widespread studies across different regions of India because our genetic and environmental makeup varies so much.”
He mentions that autoimmune diseases don’t just affect older adults, as many assume. “That’s a myth. It’s the younger, economically active population from teenage years to about 50 that suffers the most. When they fall ill, it affects the workforce, productivity, and families.”
Building awareness
Dr Pandey believes awareness is the first step. “We must take musculoskeletal and autoimmune diseases seriously in medical education, in media, and in public campaigns. People should know the warning signs – stiffness, swelling, fatigue – and seek timely help. The nihilism that once surrounded arthritis and autoimmune disease should end. Today, excellent treatments exist to manage these conditions and ensure patients live active, fulfilling lives.”
Public campaigns and media involvement, he says, can make a huge difference. “Just like the polio eradication programme had Amitabh Bachchan as its voice, autoimmune awareness too needs champions. Whether it’s through social media, radio, or grassroots health drives, people must be informed that these are treatable conditions not life sentences.”
Also, a balanced life with less processed food, more activity, plenty of sunlight, sleep, and self-care can help keep these conditions at bay.
(The author of this article has been suffering from RA from the last 15 years and was diagnosed with atopic dermatitis in 2019.)
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