Constant Bouts with Iritis

[Jun]

I wanted to thank Mike again for replying so quickly on the "Introduce Yourself" section, your input was very informative. I am scheduling another app. with Dr. Wong to discuss the usage of NSAID's, as i feel I do have recurrent / chronic iritis. I am also copying and pasting my info. from the Intro. section in case others may have more input to provide, thanks again everyone!

My background info: I am a 25 year old male and had my 1st real flare up in my left eye about 5 years ago not knowing what was going on. I went to see a specialist that prescribed me prednisone pills and prednisolone eye drops, and was clear of Iritis for about a 1 ½ to 2 years. After the 2 years I had another flare up that was pretty bad and I went to see an ophthalmologist this time. He tested me for TB, HLA-B27, etc. and it turned out that I was HLA-B27 positive with a mild case of Ankylosing Spondylitis. I was again given the standard prednisone pills and prednislone eye drops, but this time was also told I needed the steroid injection. Me being young and wanting to resolve this issue, listened to my doctor’s advice and did what they told. After 1 year of constant flare ups coming and going I developed a cataract and glaucoma due to the steroids and the iritis. I was prescribed Methotrexate along with folic acid and was recommended to try Remicade. Later I was also advised to see Dr. Ira Wong in UCSF, who also recommended that I should try Remicade to get the Iritis under control so that they could operate on the glaucoma as it already did some permanent damage to my left eye. I eventually went on Remicade and got the Trabeculectomy Glaucoma surgery and the cataract surgery.

After the surgery my central vision on my left eye was fine but my peripheral vision was permanently damaged. Remicade did help with my iritis / uveitis problems for about 6 months. Dr. Wong saw improvements and wanted to extend the dose time from every 8 weeks to every 10 weeks. After the switch, on the 9th week I had another flare up and was put back on Remicade to every 8 weeks and I was prescribed Prednislone drops again. After switching back to every 8 weeks I was soon clear again but to only have another flare up about 2 weeks later. I am currently back on the Prednislone drops today to about 4 times a day along with Istalol to control my pressure. I also have opacification on the back of the lens but was told that could be fixed by laser. I have a couple of questions:

♦ I was interested at looking into the NSAID medications (Celebrex, Dolobid or Indomethacin SR) but am totally ignorant about them. I would think those medications would be better suited for me as the steroid drops causes my pressure to fluctuate?

♦ I was also wondering if my body would start to become more tolerant of the Remicade which could lead to the flare ups occurring again and could also lead to me having to increase the Remicade dosages.

♦ I plan on seeing Dr. Wong again next week to discuss the usage of NSAID's, are there any specific questions I should be asking?

I am also currently very active, running about 2 miles at least 5 times a week and working out regularly. Does being this active have any affects with my iritis / uveitis? Any input would be greatly appreciated, thanks again for taking the time out of your day to read the following.

Jon

[Mike Bartolatz]

you are most welcome Jon.

I have been very ill for about 2 weeks. infection requiring Cipro an antibiotic ( for another week) and nerve pain requiring Neurontin. I caught the Crud probable viral in nature as the CIpro isn't helping so I have been a bit remiss in responding here and to other sites.

I do hope that Dr Wong will get the recurrent HLA B27 iridocyclitis that you have under control quickly. A steroid sparing approach is the best if at all possible for you because of long term consequences of the steroids causing cataracts for sure and possible glaucoma to occur. allot of doctors feel this is acceptable to have occur, others feel differently including most patients when told of alternative methods such as NSAIDs but all things have potentially serious consequences. NSAIDs can effect internal organs such as the liver, kidneys and heart. they can also cause Stevens Johnsons syndrome which is quite serious with effects the eyes.

Wishing you the very best,
Mike

[CindyL]

Hi Jon,

You've been through so much - My Iritis became chronic at my 4th reoccurance (This was over a 6 year period) and we just couldn't get it cleared up. I was on steroid drops for 5 months - it would clear up then as soon as I would strat to get down to 2 drops a day it would come right back. I've been seeing Dr Foster in Cambridge, MA - and I am on on Celebrex twice a day and have had excellent results - have been off the steroids for 3 weeks now and I feel great/normal. (If you want to see "my story" look at 4th go round). I haven't had any side effect from celebrex - but did get a stomach bug last week and at first thought it was from the Celebrex but fortunately it wasn't. As far as working out - I have been working out through this whole process - I do at least 2 miles a day 6 days a week and get to the gym at least 3 times a week - I'm twice your age and it really helps me physicllay as well as mentally to stay fit. Hang in there - looks like you are on the right track!

Cindy

[Mike Bartolatz]

Jon,
you asked about long term Remicade use, there are reports that it loses effectiveness in time in some individuals. it can also cause Lupus like symptoms in some people.

once your eyes are quiet and on NSAID therapy for Six months without inflammation in the eye, you will most likely be well treated with NSAIDs.

Humira is another TNF A inhibitor that can be injected often used in conjunction with Methotrexate, cellcept etc. it's antibodies are from humans rather than other animals as is the case with Enbrel (no use in Uveitis) and Remicade (very useful) it is also very expensive l.ike the other biologicals.

Wish you the very best,
Mike

[Mike Bartolatz]

Cindy,
I'm glad you continue to be free of inflammation with the Celebrex therapy.

say Hi to C Stephen Foster on your next visit for me please,


Best wishes,
Mike

[kingfisher610]

I was a big runner as well, before all of this uveits and such started. Was running 3 miles per day, each and every day and as much as five at least twice a week. Then I broke my collar bone and that killed my running. Been trying to get back into it but it seems like my joints and ecspecially my collar bone have constant aches these days. its been over a year since the break. still in good condition, but i tend to use the eliptical trainers more these days because I figure the less impact the better for me for now. Funny that so many runners seem to have this condition. Interesting? Also at work today, was told of another sailor showed up today at the Hospital complaining about snow in his vision and was unable to drive. I am curious, to find out if it was floaters. Once while at the hospital the technicain let it slip that the Hospital (Canadian Military Hospital) had about four patients with Iritis including myself. which seems odd since the navy divided between both coasts only has 8500 members yet this coast has a hospital that servers about two thirds of those members has four people with Iritis. That would make the ratio of memembers with Iritis to a ratio of almost one in a Thousand. That seems awful high compared to ratio of people with this condition to the general public. I hope for his sake that its not this condition, though I would love to be able to talk with the others on this coast in the military with this condition as we face unique challanges.

My best to you all

Steve

[Mike Bartolatz]

Actually the incidence of uveitis of all forms combined is about 11 to 15 per 100,000 population so 1 in 1,000 is about right. the question becomes from what are the people on your base getting uveitis., In a single sailor environment one would first think about sexually transmitted disease processes that can cause or trigger disease.
these things include Syphilis, gonorrhea, Chlamydia T., klebsiella and yertsina as well as from other causes such as shigella when one is in the middle east on land and a bout of dysentry occurs. Leishmaniasis is another cause in the middle east and central asia. africa and south america, central america and Norhtern Mexico. ( I posted a bunch of information on this in our related conditions forum for Iraq war, Afghanistan and surrounding countries for our members to consider as many of the pathogens on the list can cause or trigger uveitis, even the HLA B27 positive diseases/arthropathies.

wish you the best Steve,
mike

[kingfisher610]

Funny, enough the first thing they checked me for to was STDs. I know I have been a good boy, but they insisted. Guess, given the reputation of sailors its probally a logical place to start. Ofcourse I came back clean, and I would like to think in this day and age that my fellow sailors would have the good sense to protect themeselves. Thanks for the info though mike, I am surprised that there are that many incidences of uveitis. Our Navy is so small only about 6000 on this coast, so everybody seems to know everybody. I am surprised I have not heard of anyone else with this condition yet. I have heard rummors about others thru the hospital but have not met anyone in the fleet yet. Thanks again as always

Steve

[Mike Bartolatz]

Food poisoning can also trigger through Salmonella, listeria etc

Chlamydia Pneumonea which causess pneumonia and perhaps other things can also trigger uveitis and perhaps HLA B27 related disease. it is NOT A SEXUALLY transmitted disease but is airborne or ingested. I just put up some information on this topic

mike