Related new issues?

[refinnej30]

I was diagnosed with HLA-B27+ Iritis in 1999. I'd been flare free for almost 3 years and last month I had a bad flare. I had a flare due to Cipro and Allergy testing. At least I know why I flare now. It's now calm and I'm weaning off the meds. Normally when I'm on Pred Forte I only need a few hours of sleep and have tons of energy, but this time I am so exhausted I can barely function most of the day. I made some positive life changes this year and took a fittness class. I've changed my diet and began exercising 5 days a week and I've only lost 7 pounds in 4 months even though in the past I would have dropped 30 pounds with the work I've put in. My professor suggested there was something else going on and to see my dr. I've had blurry vision and my eye dr. told me there was nothing wrong with my eye (after my glare cleared). My blood sugar was somewhat erratic, but blood tests show it is in normal limits. I'm pretty sure I have PCOS, but I've been dealing with that issues for years. I went in for some tests last week and some flags came up for the first time. Vitamin D is low (I get that ocassionally since moving to New England) but now I am also low in Calcium, my Albumin is low, my Globulin is high, the A/G ratio is real low, neutophil is high (higher than it's ever been in previous labs) and lympocyte is low. Not sure I have a lot of faith in my Primary Dr. I told her I could tell her I was low in Vit D a month ago, but she said wait until the nest visit to test. I will be asking for the normal referrals to see a GI, Rheumy and Dr. Foster. I've checked previous labs and never had issues with A/G. Is this HLA-B27 related or is this something new? I normally feel better by now. I am concerned something else is wrong. Any experience with this? Thanks.

[Mike Bartolatz]

i really don't know and DR Foster can help you with this as he is a board certified Rheumatologist as well as the top ocular immunologist in the World. the uveitis is most likely related to the HLA B27 gene but the other things might require other genes to cause them. PCOS is connected if I recall correctly. the Vitamin D and Calcium is of concern and you might want to start taking some supplements for that but make sure you get followup blood tesing for this as rarely vitamin D can cause elevated serum calcium which can cause a lot of michief. as with anything we have to make sure one thing doesn't cause more problems down the road.
do you have severe dry eyes that can contribute to blur of vision or aversion to light?
if nothing can be seen on visual exam, you might need a fluorescein angiogram or Optical Coherence Tomography test to look for fluid build up under the macula, Cystoid Macular Edema or blood vessels leaking fluid. these are long term consequences of under treated iritis/uveitis.
Dr Foster can do these tests depending on what he feels might be contributing to this.
have you had your thyroid tested? this can make it very difficult to lose weight if it isn't giving off proper amounts of thyroid hormones.
unless you are taking oral steroids, they shouldn't contribute to type II diabetes but there is a genetic component to this type of diabetes and I have it. it presented with a vengance in my early 40's. at first diet and exercise worked to control it. then I went on oral drugs after about 10 years. then I started with a couple of shots of insulin at bedtime and in the morning. now I am a 'brittle diabetic' requiring 5 shots of two kinds of insulin a day. I will be going on an insulin pump in a couple of weeks once it is approved by insurance.

the IL1 B gene plays a role in diabetes and forms of arthritis too. you might ask to be tested for it. it can also be present in many forms of autoimmune disease processes as an inflammatory cytokine producer that triggers the TH1 immune response,
the IL23R and ERAP1 genes also interact causing inflammation in ankylosing spondylitis, autoimmune thyroid disease, crohn's disease, breast cancer and sometimes other conditions such as Systemic Lupus Erythematosus and Behcet's disease.

I also have Fibromyalgia and this makes me very tired all the time. you might ask to be checked out for this if you have muscle pain and muscle cramping going on.
you mentioned Cipro, what were you taking this antibiotic for? a GI complaint? GI pathogens trigger the HLA B27 diseases. often H pylori is a trigger for them. this pathogen is also found in fluid inside the eye causing anterior uveitis and glaucoma. it has also be found in atherosclerotic plaque in arteries and heart disease.

have you ever tried NSAID therapy? DR Foster finds this to work in about70% of HLA B27 related uveitis.


wishing you some energy and quiet eyes,
mike