Women at greater risk for autoimmune diseases with ocular manifestations
Posted Sep 11 2009 4:56pm
Women at greater risk for autoimmune diseases with ocular manifestations Communication with physicians managing the patient’s systemic disease is crucial.
by Katrina Altersitz
Women are as much as 50 times more likely to suffer from certain autoimmune diseases than men, and these diseases often have ocular manifestations that ophthalmologists should be aware of when examining their female patients, experts say.
“Autoimmune diseases are the No. 1 example of the higher risk” women carry for certain diseases due to sex, said Janine A. Smith, MD, of the National Eye Institute. “There are a lot of autoimmune diseases, and nearly every single one affects women more than men.”
There is no definitively known reason for this disparity between the sexes, she said. Dr. Smith said Sjögren’s syndrome, with its symptoms of dry eye and dry mouth, is a prime example of an autoimmune disease seen more often in women. In addition, she said, systemic lupus erythematosus, rheumatoid arthritis and thyroid disease all disproportionately affect women, and all can have ophthalmic manifestations.
“The immune system between men and women is different,” Dr. Smith explained. “Even the way men respond to viruses and women respond to infections, there are differences.”
One theory, she said, is that because estrogens are naturally proinflammatory and androgens, specifically testosterone, are considered anti-inflammatory, women are more prone to developing autoimmune problems.
OSN spoke with Dr. Smith and other experts regarding the ocular complications of autoimmune disorders, what can be done to treat them and how to work with internal medicine specialists and others in management of patients with these diseases.
Three times as many women as men experience scleroderma, or progressive systemic sclerosis, a connective tissue disease.
“Scleroderma is a very different beast from lupus and rheumatoid disease, with less known about it and less discovered thus far in terms of a routinely highly effective therapy,” Dr. Foster said. “Breakthroughs are being made, and there are increasing levels of optimism among the medical community with respect to being able to prevail over some of the more relentless manifestations of scleroderma.”
Patients with scleroderma are likely to develop dry eye, which is treated as in other autoimmune diseases. The condition also causes shrinkage of areas of the skin, including the conjunctiva, Dr. Foster said.
“Patients sometimes develop shrinkage of the conjunctiva with a shortening of the inferior fornix,” he said. “It probably has to do with laying down new collagen, perhaps type 3 collagen or embryonic collagen. This contracts and you get shrinkage.”
Choroidopathy and vascular occlusion can also occur.
“Just as in lupus, this is a wake-up call that the patient’s scleroderma has taken a nasty turn,” Dr. Foster said.
Unfortunately, he said, there is no treatment for conjunctival shrinkage, and clinical trials for treatment of vascular occlusions are “maddeningly difficult” because of the small number of patients in any one center.
“One could speculate that the same approach that has been employed in the scleroderma lung research, namely with high dose cyclophosphamide therapy intravenously and other kinds of aggressive immunosuppressive therapy, might be beneficial in patients who are developing the scleroderma choroidopathy, but frankly it’s not known,” Dr. Foster said.