Yoon Hang “John” Kim, MD, MPH

Board-Certified in Preventive Medicine  |  www.directintegrativecare.com

February 2026

Introduction

Autoimmune diseases have long been framed as conditions of youth and middle age. Systemic lupus is the “young woman’s disease,” type 1 diabetes is “juvenile,” and multiple sclerosis typically presents between ages 20 and 40. Yet a growing body of epidemiological evidence is rewriting this narrative. Large population-based studies now demonstrate that for many autoimmune conditions, incidence and prevalence not only persist but increase with advancing age, imposing disproportionate burden on adults over 60.

This article reviews the current evidence on aging and autoimmune disease risk, examines the immunological mechanisms underlying this relationship, and discusses implications for clinical practice—particularly through the lens of integrative and functional medicine.

Epidemiological Evidence: Autoimmune Disease Burden Rises With Age

Global Burden Data

A comprehensive analysis of the Global Burden of Disease (GBD) data spanning 1990 to 2021 reveals that age-standardized incidence of several key autoimmune diseases—including rheumatoid arthritis (RA), psoriasis, inflammatory bowel disease (IBD), type 1 diabetes (T1D), and multiple sclerosis (MS)—has risen steadily across aging populations, with particularly steep burdens in adults aged 60 years and older (Wang et al., 2025). Among this age group, psoriasis showed the highest age-standardized incidence, followed by RA, IBD, T1D, and MS. Projections based on current trajectories suggest further increases through at least 2035.

Geographically, the Americas and Europe carry the heaviest autoimmune disease burden in older populations, reflecting both genuinely higher incidence and robust case ascertainment in high-income regions (Wang et al., 2025). Decomposition analyses attribute the rising burden primarily to population aging and growth, with improvements in surveillance and treatment moderating mortality but failing to offset the growing case load (Cai et al., 2024).

Population-Level Studies

A landmark 2023 UK population study analyzing data from 22 million individuals confirmed that several autoimmune conditions—including Graves’ disease, Hashimoto’s thyroiditis, pernicious anemia, and RA—show increasing incidence with age (Autoimmune Institute, 2023). Notably, the study revealed that not all autoimmune diseases follow a simple linear age trajectory; IBD, for instance, exhibits multiple age peaks rather than a monotonic rise, suggesting distinct pathogenic windows across the lifespan.

For RA and psoriasis specifically, incidence and prevalence peak around age 70 and then decline somewhat—a pattern likely attributable to survivor bias, under-diagnosis in the very old, and competing causes of mortality rather than a true decrease in disease occurrence (Wang et al., 2025).

The “50% Increase” Finding

Clinical summaries directed at older adults, including recent reporting from NYU Langone and AARP, note that the risk of several common autoimmune diseases is now approximately 50% higher in older people than it was 25 years ago (NYU Langone Health, 2024). While part of this increase reflects improved detection and shifting diagnostic criteria, the magnitude of the trend argues for genuine biological and environmental contributors that compound with age.

Mechanisms: Why Aging Increases Autoimmune Risk

The relationship between aging and autoimmunity is not simply a matter of cumulative exposure over time. Rather, specific age-related changes in immune architecture create a milieu that is permissive—and in some cases, actively promoting—of autoimmune pathology.

Immunosenescence and Thymic Involution

The thymus, which serves as the primary organ for T-cell maturation and central tolerance, undergoes progressive involution beginning in puberty and accelerating after age 40. By age 60, thymic output of naïve T cells is profoundly reduced, limiting the immune system’s capacity to generate tolerant, antigen-specific responses while simultaneously favoring the persistence and expansion of autoreactive T-cell clones (Jafarzadeh et al., 2019). This process—broadly termed “immunosenescence”—does not render the immune system inert; instead, it redirects immune function toward a state characterized by chronic, low-grade activation and impaired regulatory oversight.

Inflammaging

Franceschi and colleagues coined the term “inflammaging” to describe the phenomenon of age-associated chronic systemic inflammation that occurs in the absence of overt infection or injury (Vadasz et al., 2013). Inflammaging is characterized by elevated circulating levels of pro-inflammatory cytokines (IL-6, TNF-α, IL-1β), increased C-reactive protein, and persistent activation of innate immune pathways. This inflammatory milieu provides the “kindling” for autoimmune responses by reducing the threshold at which self-reactive lymphocytes become pathogenic.

Altered B-Cell Function and Autoantibody Accumulation

Aging is associated with measurable increases in circulating autoantibodies, including rheumatoid factor, antinuclear antibodies (ANA), and anti-thyroid antibodies, even in individuals without clinically apparent autoimmune disease (Vadasz et al., 2013). This reflects both intrinsic B-cell dysregulation and the failure of peripheral tolerance checkpoints. Importantly, clinicians must interpret autoantibody results in elderly patients with appropriate caution, recognizing that age-adjusted reference ranges may be needed to avoid both over- and under-diagnosis.

Declining Regulatory T-Cell Function

Regulatory T cells (Tregs) play a critical role in maintaining peripheral tolerance by suppressing autoreactive effector cells. While Treg numbers may be maintained or even increased in aging, their suppressive function becomes impaired, contributing to a net loss of immune homeostasis (Jafarzadeh et al., 2019). The result is an immune system that simultaneously underperforms against novel threats and overreacts against self-antigens.

Hormonal Influences and Sex Differences

The relationship between sex hormones and autoimmunity adds another dimension to the aging–autoimmunity axis. Epidemiological data demonstrate that the female predominance of RA becomes more pronounced with advancing age, with the male-to-female ratio shifting from approximately 1:2 in younger adults to 1:4 in older adults (Joo et al., 2024). Post-menopausal hormonal changes—particularly declining estrogen, which has complex immunomodulatory effects—likely interact with cumulative environmental exposures to amplify autoimmune risk in aging women.

Clinical Implications: Under-Recognition and Under-Treatment

Despite the epidemiological evidence, autoimmunity in elderly patients remains substantially under-recognized. Reviews of clinical practice patterns indicate that autoimmune symptoms in older adults are frequently misattributed to “normal aging,” degenerative disease, or comorbid conditions, leading to significant diagnostic delays (Ramos-Casals et al., 2003). The consequences of delayed diagnosis are compounded in elderly patients, who experience accelerated disability accumulation and greater treatment-related morbidity.

Global burden analyses confirm this concern: disability-adjusted life years (DALYs) and mortality from RA and IBD rise steeply with advancing age, with the heaviest toll falling on the “oldest-old,” even when incidence appears to plateau or decline (Cai et al., 2024). This paradox—stable or decreasing incidence but rising disability—underscores the cumulative, progressive nature of autoimmune tissue damage in aging populations.

Authors writing on this topic consistently stress the need for age-aware diagnostic thresholds, careful interpretation of autoantibodies in elderly patients, and proactive management strategies that prioritize preservation of function and quality of life (Vadasz et al., 2013).

The Integrative Medicine Perspective

For integrative and functional medicine practitioners, the aging–autoimmunity nexus represents both a challenge and an opportunity. Several principles of integrative practice are particularly well-suited to addressing this population:

Root Cause and Upstream Intervention

Rather than waiting for frank autoimmune disease to manifest, integrative clinicians can identify and address upstream drivers of immune dysregulation in aging patients. These include intestinal permeability (which increases with age and NSAID use), chronic infections, environmental toxic exposures (including mold), nutritional deficiencies (vitamin D, zinc, omega-3 fatty acids), and dysbiosis. Functional medicine testing—including comprehensive stool analysis, organic acids testing, and environmental toxicant panels—can guide targeted interventions before autoimmune cascades are fully established.

Modulating Inflammaging

Given the central role of inflammaging in age-related autoimmunity, interventions that reduce chronic systemic inflammation are of paramount importance. Evidence-based strategies include anti-inflammatory dietary patterns (Mediterranean, modified elimination diets), targeted supplementation (curcumin, SPMs/resolvins, omega-3 fatty acids), stress reduction practices (mindfulness, yoga, tai chi), regular moderate exercise, and optimization of sleep quality. Low-dose naltrexone (LDN), which has demonstrated immunomodulatory properties through transient opioid receptor blockade and subsequent upregulation of endogenous endorphins and enkephalins, is an additional tool that warrants consideration in this population.

Personalized, Relationship-Centered Care

The complexity of autoimmune disease in aging patients—with polypharmacy, multimorbidity, and the need for careful risk–benefit analysis of immunosuppressive therapies—demands a care model built on deep patient–provider relationships and individualized treatment planning. Direct care and membership-based practice models, which allow for longer visits and longitudinal continuity, are particularly well-positioned to serve this growing patient population.

Conclusion

The evidence is clear: autoimmune disease is not exclusively—or even primarily—a condition of the young. As global populations age, the burden of autoimmunity in older adults will continue to grow, driven by the fundamental biology of immune aging. Clinicians must update their mental models to reflect this reality, incorporating age-appropriate screening, adjusted diagnostic thresholds, and proactive management strategies. Integrative and functional medicine, with its emphasis on root cause identification, inflammation modulation, and personalized care, is uniquely positioned to meet this challenge.

About Dr. Kim

Dr. Yoon Hang "John" Kim is a board-certified integrative medicine physician with over 20 years of clinical experience. He completed his integrative medicine fellowship at the University of Arizona under Dr. Andrew Weil and holds certifications in preventive medicine, medical acupuncture, and integrative/holistic medicine. Through his telemedicine practice, Dr. Kim specializes in utilizing LDN or Low Dose Naltrexone for treating autoimmune conditions, chronic pain, integrative oncology, and complex conditions including fibromyalgia, chronic fatigue, MCAS, and mold toxicity. He is the author of three books and more than 20 articles, and has helped establish integrative medicine programs at institutions nationwide.

Professional: www.yoonhangkim.com | Clinical: www.directintegrativecare.com

References

1. Autoimmune Institute. (2023). Aging and autoimmune disease. Retrieved from https://www.autoimmuneinstitute.org/articles/aging-and-autoimmune-disease

2. Cai, S., Chen, Y., & Wang, L. (2024). Global burden of rheumatoid arthritis and inflammatory bowel disease among older adults: Trends in incidence, prevalence, mortality, and disability-adjusted life years, 1990–2021. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC11227207/

3. Jafarzadeh, A., Nemati, M., & Khoramdel-Azad, H. (2019). Age is a major risk factor for autoimmune disease in case of older people. OMICS Online. https://www.omicsonline.org/open-access/age-is-a-major-risk-factor-for-autoimmune-disease-in-case-of-older-people-124420.html

4. Joo, Y. B., Lim, Y. R., & Shim, J. (2024). Epidemiology and pathogenesis of rheumatoid arthritis: A comprehensive review. Nature Signal Transduction and Targeted Therapy, 9, Article 1952. https://www.nature.com/articles/s41392-024-01952-8

5. NYU Langone Health. (2024). Risks of common autoimmune diseases increase in older people. AARP. https://nyulangone.org/news/aarp-risks-common-autoimmune-diseases-increase-older-people

6. Ramos-Casals, M., García-Carrasco, M., & Brito-Zerón, P. (2003). Autoimmunity and geriatrics: Clinical significance of autoimmune manifestations in the elderly. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC4277694/

7. Vadasz, Z., Haj, T., Kessel, A., & Toubi, E. (2013). Autoimmunity in the elderly: Insights from basic science and clinics. Gerontology, 63(6), 515–523. https://karger.com/ger/article/63/6/515/147650/Autoimmunity-in-the-Elderly-Insights-from-Basic

8. Wang, H., Zhang, Y., & Li, X. (2025). Global burden of autoimmune diseases in older adults aged 60 years and above, 1990–2021: An analysis from the Global Burden of Disease Study 2021 with projections to 2035. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC12711659/

Disclaimer: This article is intended for educational and informational purposes only and does not constitute medical advice. Patients should consult their healthcare providers for personalized evaluation and management of autoimmune conditions.

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