Questions about Iritis...

[diane_s]

Posted: Wed Mar 28, 2007 7:23 am Post subject: HLA B27+ AS

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Good morning... I just posted in the new member area but I do have a few questions and wonder if someone might have a suggestion...

I am 37, female and diagnosed with HLA B27 AS about 10 mos ago. My symptoms have been growing since October 2003. I understand this is an unusual diagnosis for women, and the rheumatologist that I was referred to when my own MD was exhausted of ideas, was equally surprised to see that B27+ in my labwork. Anyway...

I have been struggling to reach success with the Hydroxychlorquine 200mg BID and the increasing dosage of MTX over the last year and a half and have finally reached the point of 'failure' so I can move on to a trial of Enbral that I am working forward to trying in 3 weeks. I found my way to this site quiet by accident..... here is my story!

I have been having R eye pain for about a week now... coming and going in intensity but feeling like a 'caffine' detox headache or a low grade migrane. Yesterday I began having blurred vision just in the R eye... and it feels weird.. its hard to describe.. when I blink or move my eye to look around. This morning i was literally blinded by the sunlight and it caused a sharp stabbing pain. My eye waters incessently.

I about fell off my chair when I did a google search on eye pain and saw the correlation of Iritis to my AS condition. Does this sound like something any of you have experienced as Iritis??

Any help would be appreciated... Thank you!
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~diane

[Mike Bartolatz]

Hi dianne,
it could be iritis and you will need a slit lamp exam by an opthalmologist to confirm it.
DMARD meds like MTX sometimes need to be 'pushed' to higher limits for uveitis than what rheumatologists usually employ for just arthritis. ENBREL will NOT help with uveitis. Remicade or Humira might be a better choice but usually an NSAID such as Celbrex or Dolobid are tried first along with the MTX. injectible MTX has fewer side effects than the oral and less is needed to get the job done.
where do you live? perhaps we can suggest a specialst for a consultation if one is near you.

wrap around polarized sunglasses are needed to help with the aversion to light as well as glare off of computer screens. lowering lighting in ones work environment and switching to an indandescent lamp helps too. I use Dark green fit over sunglasses since I wear glasses on sunny days and brown tinted ones on overcast days and inside when my eyes are acting up. you can buy them online for about 10 to 20 bucks or in optical shops or sporting goods stores for 25 to 50 bucks.

please read various topics here to include 'how to use eyedrops', and some of the pritable pamplets in the sticky notes of the Parent's forum.

We are here to help you in any way we can. so ask any questions you may develop. NOTHING is too trivial to ask by the way.

Wish you the very best,
Mike

[diane_s]

Thanks Mike, I appreciate the info and the welcome!

I called my eye doctor. Seems i can get in to be seen on April 11th.!! I asked them to check with the Dr to see if he thought i could wait that long.. also called my Rheumy to see what HE thought.

I am at the highest limit they will give for MTX 20mg but i have no side effects from it, just not working anymore. . I have tried the injectable with no relief. I have had a few shots of prednisone that work so well.. but are not offered very often.. yucky stuff!

I will scour this website .... from what I have read so far, it seems like a great place to find information... and others in the same boat!

[Mike Bartolatz]

Depending on your size, up to 50 can be used with the oral MTX. 25 injectible is often used to quiet the eye.
other drugs can be added like Cyclosporin to form a 'cocktail' April 1 is soon enough I would think if you can't get in tomorrow or friday. if it is iritis causing the problem they will usually start you off on topical corticosteroids with a dilating drop to help prevent adhesion between the iris and the Lens. this will blur your vision temporarily and increase sensativity to light.
you can also have dry eyes which can cause aversion to light and blur of vision so an exam is the only way to tell what is going on.
wear some dark green wrap around sunglasses outside and in if you have them. the tighter they fit to the face and brow the better. if you only have regular sunglasses wear a baseball cap to help prevent reflection of light off of your brow onto your sunglasses.

your sis a sytemic disease problem and the best way to treat the uveitis is through Oral or injectible meds. if the inflammation doesn't respond to the corticosteroid eyedrops, then oral steroids or injection to tissue surrounding the eye is done.
hopefully you can lick this quickly with topical coritcosteroids (pred forte) and dilating drops.

Wish you the very best,
Mike

[kat341]

diane,

I think the 11 th is to long of a wait. You need to tell them that it's an emergency and You need to be seen much sooner than 14 day's from now. Call your PCP and have them call the Opthamologist office to get You in asp.

Kathy

[Mike Bartolatz]

Sorry I thought it said the 1st.

mike

[Sheila]

The 11th is too long to wait! Are you sure they understood you think you have IRITIS? Even my friend who is an RN knows that iritis is treated as an EMERGENCY and the person is to be seen NOW (when I was at the ER is Salt Lake, they got me into the Moran Eye Center within an HOUR.

[kristav]

hi my name is krista and i have AS...and yes this is what i experience.....i get it so often that i start treeting it myself before i go see the DOC...i have all the drops at hope and if i start a high dose i dont end up with a long time usuing it....if i wate to long i end up doing drops for months and with injections....not to say you should start before seeing a DOC first this is just what i do because my DOC tells me to start as soon as i see the first signs of iritis starting.....have you had your blood work yet finished to see if you have AS?.....take care krista

[ashebuski]

I am a 42 year old female on my 2nd bout with Iritis. I had it the first time 10 years ago. I had the steroid injection within my first week and my recovery time was about 2 months. I was diagnosed with Iritis again on January 8th and am still struggling with the aftermath. I have been off the dialation drops for 2 months (once the doctor said the infection was over with) and my pupil is still wide open, like I'm still on the dialating drops. During the course of my treatment, there was one point in which the doctor told me to go off the dialation drops and I realize in hindsite that was a mistake. Now, I'm left with this problem and as yet do not have a resolution. I will see a different opthamologist next week. Is my eye ruined forever?

[Mike Bartolatz]

It is hard to say. where do you live? I can suggest an ocular immunologist for consultation.
it is better to have the eye dilated than constricted. you can get a tinted contact lens to match your other eye. this can happen with iritis and is sometimes related to the herpes Simplex virus. My doctor had it happen to him and he has a colored contact lens. (not my opthalmologist) if it isn't adhesion between the iris and the lens it is called iris atrophy. if caused by the herpes virus, antiviral medication are advised because of the potential for the virus to enter to the intermediate and posterior segments and it can cause major problems. a difinitive cause should be made and appropriate treatment initiated.
wish you the very best,
Mike