Autoimmune Conditions: Dry Eye Syndrome and Vascular Concerns

Autoimmune disease Sjögren's syndrome

Hello Doctor: My mother is 72 years old and has hepatitis C, Sjögren's syndrome, and severe dry eye syndrome, all of which are being treated.
As she has aged, her blood pressure has been elevated, and she is currently taking antihypertensive medication, immunomodulators, and antidepressants.
Ten months ago, a Pap smear showed inflammation, and she visited a gynecologist, receiving hormone replacement therapy for about eight months, which she stopped two months ago.
In the past two months, she has developed red spots on both legs, and the rheumatologist indicated that this is due to microvascular bleeding (inflammation).
There has been no improvement, and we are quite worried.
Doctor, could her condition be classified as "vasculitis"? Is there a connection with her previous hormone replacement therapy? Could her past use of turmeric be related? Will she recover? What would be the most appropriate way to manage this situation? Thank you.

Li, 50~59 year old female. Ask Date: 2019/06/17

Dr. Gao Jiankai reply Internal Medicine

Hello Ms.
Lee, thank you for your inquiry.
Here are the answers to your questions:
1.
Both Sjögren's syndrome and hepatitis C can potentially cause microvascular bleeding as a side effect if not continuously treated, which may appear as small petechiae.
To determine if this is related to Sjögren's syndrome, you can arrange for a blood test; this can be discussed with your physician.
2.
Currently, I have not encountered any cases where hormone therapy has caused red spots on both feet, so the likelihood seems low.
3.
There have been some isolated cases of small petechiae appearing on the lower limbs after taking turmeric.
Therefore, I suggest that you consider temporarily discontinuing turmeric and observe whether the petechiae improve.
You may consider pausing turmeric, and if there is no improvement after a week, then consult a rheumatologist.
The Allergy, Immunology, and Rheumatology Department at Changhua Hospital, Ministry of Health and Welfare, is concerned about your well-being.

Reply Date: 2019/06/17

More Info

Your mother's health situation is quite complex, involving multiple autoimmune conditions, hypertension, and recent symptoms that are concerning. Let's break down the issues and address your questions regarding dry eye syndrome, vascular concerns, and the potential connections to her hormone therapy and turmeric use.

Autoimmune Conditions and Dry Eye Syndrome
Dry eye syndrome is a common condition in individuals with autoimmune diseases, particularly in those with Sjögren's syndrome, which is characterized by dry eyes and dry mouth. Given that your mother has a history of autoimmune conditions, her severe dry eye symptoms could be exacerbated by her underlying health issues. Autoimmune diseases can lead to inflammation of the lacrimal glands, which are responsible for tear production, resulting in dry eyes.

Vascular Concerns and Microvascular Bleeding
The appearance of red spots on your mother's legs, described as microvascular bleeding, could indeed be indicative of a vascular issue, potentially related to an autoimmune process. Conditions like vasculitis, which involves inflammation of the blood vessels, can lead to symptoms such as skin rashes or spots due to bleeding under the skin. It is essential to consider that autoimmune conditions can affect blood vessels, leading to complications like vasculitis or other forms of vascular inflammation.

Hormone Therapy and Its Effects
Regarding the hormone therapy your mother underwent, it is essential to understand that hormone replacement therapy can have various effects on the body, particularly in older adults. While hormone therapy is often used to alleviate symptoms of menopause, it can also influence vascular health and immune function. However, there is no direct evidence linking hormone therapy to the development of microvascular bleeding. It is crucial to discuss any concerns about hormone therapy with her healthcare provider, as they can provide insights based on her specific medical history.

Turmeric and Its Role
Turmeric, particularly its active compound curcumin, is known for its anti-inflammatory properties. While it is generally considered safe and beneficial for many conditions, it can interact with certain medications and may not be suitable for everyone, especially those with bleeding disorders or those on anticoagulant therapy. If your mother has been taking turmeric supplements, it would be wise to consult her healthcare provider to ensure that it does not interfere with her current medications or exacerbate her bleeding issues.

Recommendations for Management
1. Consultation with Specialists: Given the complexity of your mother's conditions, it would be prudent to have her evaluated by a rheumatologist or an immunologist who specializes in autoimmune diseases. They can provide a comprehensive assessment and determine if her symptoms are related to an autoimmune process like vasculitis.

2. Monitoring and Testing: Regular monitoring of her blood pressure, liver function (due to her hepatitis C), and autoimmune markers is essential. Blood tests may help identify any underlying inflammatory processes or complications related to her autoimmune conditions.

3. Management of Dry Eyes: For her severe dry eye syndrome, consider consulting an ophthalmologist who specializes in ocular surface diseases. They may recommend treatments such as prescription eye drops, punctal plugs, or other therapies to alleviate her symptoms.

4. Lifestyle Modifications: Encourage your mother to maintain a healthy diet, stay hydrated, and manage stress, as these factors can influence autoimmune conditions and overall health.

5. Medication Review: Have her medications reviewed by her healthcare provider to ensure that they are appropriate for her current health status and to discuss any potential side effects or interactions.

In conclusion, your mother's situation requires careful management and coordination among her healthcare providers. By addressing her symptoms holistically and considering the interplay between her autoimmune conditions, medications, and lifestyle, you can help her achieve better health outcomes. Always ensure that any changes in her treatment plan are discussed with her healthcare team to ensure safety and efficacy.

Similar Q&A

Understanding Rheumatoid Arthritis: Eye Symptoms and Immune System Links

Hello, Doctor. I started experiencing dryness and pain in my left eye last year. Last month, I suddenly developed scleral inflammation in my right eye. After seeking medical attention, my condition is currently stable. Recently, I underwent dry eye testing (using tear break-up ti...

Dr. Zeng Guosen reply Internal Medicine
Hello, dry eyes and scleritis can be manifestations of rheumatic diseases affecting the eyes. If the rheumatoid factor is positive, it is recommended to consult a rheumatologist for differential diagnosis, as rheumatic diseases do not always present initially with joint symptoms.

Understanding Autoimmune Thyroiditis: Symptoms, Tests, and Treatment Options

Hello, Doctor. I have been tracking thyroid issues for many years. In November of last year, my tests showed TSH 4.43, Free T4 0.84, and anti-TPO 9295, along with asymmetrical eyes, with the right eye protruding. I have been experiencing chronic dryness in my eyes, and in Novembe...

Dr. Li Jian reply Internal Medicine
It is recommended that you visit a medical center to see an endocrinologist and check for TSH receptor antibodies, as this antibody is related to exophthalmos. Thank you for your inquiry.

Understanding Eye Symptoms and Complications in SLE Patients

Hello Doctor: I am a patient with SLE (Systemic Lupus Erythematosus) and have been diagnosed for 16 years. I have undergone cataract surgery in my left eye and also have dry eye syndrome. Recently, I visited an ophthalmologist for my dry eye condition, and the doctor mentioned th...

Dr. Zeng Guosen reply Internal Medicine
1. Systemic lupus erythematosus (SLE) may be associated with dry eye syndrome, intraocular vasculitis, or cataracts caused by corticosteroid use. 2. Determining whether your dry eye syndrome is related to SLE must be assessed by a clinic physician; currently, there is no blood ...

Understanding Allergic Vasculitis: Is It Drug Allergy or Immune Issue?

In recent weeks, I have seen a doctor and taken medication for a cold and cough. Subsequently, I was prescribed antihypertensive eye drops due to elevated intraocular pressure. During this time, another doctor advised me that the side effects of the eye drops were significant and...

Dr. Huang Ruiyun reply Dermatology
Allergies are a type of immune response, and medications are common triggers for allergic reactions. The cause of allergic vasculitis may be related to medications, but there are no definitive tests to confirm this. Therefore, it is advisable to follow the physician's recomm...