Sex and Gender Differences in Pulmonary Manifestations of Autoimmune Disease

Although only 8% of the population develop autoimmune diseases (AD), 78% are women. The pulmonary manifestations range from mild to life-threatening and the severity depends on the AD. In some AD, such as rheumatoid arthritis (RA), gender differences are well recognized. More men develop pulmonary disease in RA, which includes interstitial lung disease, rheumatoid nodules, and pleural effusions. In scleroderma, 40-80% of patients develop pulmonary complications that contribute to the high mortality rate. Sjögren's syndrome has a low mortality rate and rarely involves the lungs. This chapter focuses on the literature available on sex hormone differences in the pulmonary manifestations of RA, scleroderma, and the association of Raynaud's phenomenon. Women appear to have increased susceptibility to most AD, excluding RA. The available clinical data are minimal and support further research and clinical studies to define the role of hormones in the lung and their role in AD.