Isolating triggers for Iritis flare-ups

Post here to exchange iritis general information and support with others.

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Isolating triggers for Iritis flare-ups

Postby SanDiegoIritis » Tue Mar 31, 2009 7:11 pm

Hi Everyone,

I just joined today, out of desperation. I've had Iritis for over 15 years but was gaining confidence as the attacks were diminishing. The last year they have increased in frequency and severity. I got my first shot last week, that's an experience! I found Zyflamend this week online and started that, as well as all the Opth has me on (Predforte, Xibrom, Homatropine, and Cosopt (for pressure). My question is: has anyone noticed flare-ups following a cold/flu, etc? In looking back at what was going on before my latest attacks, I'm remembering I was sick with something that would have kicked the immune system into gear just a couple weeks prior. I wonder if a course of Aleve following a cold, etc. is a way to ward off attacks.

Thanks, Judy
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Re: Isolating triggers for Iritis flare-ups

Postby Mike Bartolatz » Tue Mar 31, 2009 7:40 pm

to me it sounds like you have chronic uveitis which might benefit from NSAID therapy IF it isn't related to a pathogen.
often prescription strength Oral NSAIDs can help conquer chronic iritis. often Celebrex, Difusinal, Naprosyn, Idomethacin SR are used for about six months to see if they can help. if not, then one moves on to DMARD drugs used to stop the attack on the eyes by the immune system. have you been tested for common causes of iritis such as the HLA B27 gene? do you have any underlying forms of arthritis, skin rashes, Gastro Intestinal problems? any neurological or vascular problems?
chronic iritis is serious stuff. are you under the care of an Uveitis specialist? Dr Levinson is such a specialist in UCLA.
Dr Rao is one at Doheney eye institute in LA. they may be able to figure out WHY your uveitis is chonic.
Contact information for these doctors can be found at http://www.uveitis.org in the PATIENT information section of the site.

Sadly I know of no one in San Diego.

wish you the best,
Mike
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Re: Isolating triggers for Iritis flare-ups

Postby SanDiegoIritis » Tue Mar 31, 2009 8:39 pm

Yes, I forgot to include some details, myself and my brother with Iritis have HLA B27, but neither show any other ailments except "regular" arthritis. Everything else has been ruled out like lupus, AS, RA, etc. I am 50 now and have shown up with Osterporosis, which I swear is connected. I feel like my body is pulling that calcium out for a reason, but sometimes I don't know where I get these ideas! Now I"m on Evista to fix that. I have read about the specialists in LA and asked my Opthal (Leung) if I should go to an Iritis specialist and he said they wouldn't do anything different. Getting to LA wouldn't be convenient on any sort of regular basis, so I don't know if you just mean for a screening. My Rheumatologist is keeping me on annual visits to check bone density, and has prescribed 50,000 Vit D. I have no GI or skin probs thankfully! I'm a little worried about long term NSAID therapy. That's why I bought Zyflamend. Have you heard of that?

You've never heard of people getting flare ups following other minor illnesses?

Thanks again, Judy
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Re: Isolating triggers for Iritis flare-ups

Postby Mike Bartolatz » Tue Mar 31, 2009 9:00 pm

No I haven't heard of that.
the NSAID therapy would be for two years once off all steroids without inflammation. the steroid eyedrops, shots and oral will eventually lead to cataract formation and possibly Glaucoma. a stepladder approach to treatment was developed years ago by Dr C Stephen Foster at Harvard. this is for autoimmune uveitis (HLA B27) wherein one tries NSAIDs first to stop the cycle. often this stuff will progress to posterior complications of the choroid and retina long term.
the dose of Celebrex would be 200 twice a day for two years, then down to 200 once a day for six months then stop.
cataract surgery can only be done after ones eyes are totally quiet for three months. glaucoma can occur from the eyedisease as well as the steroids as can cataracts. osteoporosis is very common in men. steroid use (oral) can bring this about quickly in some individuals. ask the rheumatologist to put you on one of the NSAIDs I mentioned above. Celebrex has the best track record but is expensive. then the generic Difusinal works very well as can Naprosyn and Indomethacin SR.

I was only given steroids for over 35 years with this stuff and I developed complications to the steroids and the disease. posterior segment involvement included glaucoma, epiretinal membrane formation and cystoid macular edema. I also developed cataracts which I did have removed about 10 years ago and had Intra ocular lens implants. my eyes flared terribly after each surgery requiring multiple steroid injections to tissue around my eyes to get them calmed down. glaucoma took out peripheral vision in my left eye. the Veteran's administration rates me as blind in my left eye with significant loss of vision due to epiretinal membrane and scotoma from CME in the Right eye as well as some peripheral vision loss. I truly wish I had been told about alternatives to steroids. so I could try to prevent all of this from occuring.

Wish you the best,
mike
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Re: Isolating triggers for Iritis flare-ups

Postby SanDiegoIritis » Sat Apr 04, 2009 12:36 am

I had my follow up and the inflamm is down from 4 to 2. Doc insists on continuing the Pred Forte although I don't think it's working. I just read today about the results people are posting with Durezol. I will call him Monday and ask about switching! I'm also taking 400 mg Naprosyn OTC on my own, and trying an herbal product called Zyflamend. I took 2 days off and pampered my eyes, so I think that rest really helped get on top of the flare up. I think it's important to get away from hours of computer work and overhead flourscent lighting until the pain is diminishing.

I also read about the guy from Calif who noticed spring and fall flares. I've noticed that too, so possible allergen causing trigger? Another post from a girl mentions flare up after or during a cold. I've noticed that too. I'm going to pursue the course of action Mike recommends for 2 years on a prescript anti-inflamm and then taper off. Hopefully I can get my Rheumatologist to go along with this plan. Sometimes you have to bring these ideas and sell the docs on them!! The drug companies are in there selling them their plans!!

Thanks everyone for all the shared valuable info!! I'm praying for us all,,,,,

Judy in San Diego
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Re: Isolating triggers for Iritis flare-ups

Postby Mike Bartolatz » Sat Apr 04, 2009 10:24 am

Pred forte is a perfectly good way to go. It worked for me very well for many years.

you have to be monitored for problems associated with long term use of NSAIDS, stomach, liver, Kidney and heart.
it doesn't matter if it is OTC aleve or Prescription Naprosyn, the side effects are the same.

wish you the best,
Mike
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Re: Isolating triggers for Iritis flare-ups

Postby SanDiegoIritis » Sat Apr 11, 2009 8:54 pm

Hi Mike,

Update on doc visits: Opthal said Durezol is not a formulary on my HMO plan, but he feels strongly that the PredForte is just as effective. The Rhuematologist has put me on Mobic, 15 mg daily, to try and prevent further attacks. I told him about this forum and that many people were seeing results with using daily NSAID for a significant period of time. He also prescribed Sulfasalazine (500 mg) twice a day, but after reading up on it I decided not to take it. Even the pharmacist said it doesn't make sense for Iritis. It's for Colitis and is only absorbed into the intestine. I'm looking into a new Rhuematologist.

Any thoughts? I'm at the end of the attack now, just getting the flashing lights where I can "see" my heartbeat, interesting how visual inflammation works!

Thanks, Judy
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Re: Isolating triggers for Iritis flare-ups

Postby Mike Bartolatz » Sat Apr 11, 2009 9:09 pm

The pharmacist is right about the sulfasalzine not working for uveitis.
As I have indicated many times the Nsaids that work the best are Celbrex, difusinal which is only found as a generic, Indomethacin and Naprosyn taken at prescription dose to see if you can get off all steroids without inflammation. if it doesn't work within the first six months, then one moves on to DMARD drugs such as Methotrexte, Cellcept etc. Plaquenil is often used to control some of the forms of Rheumatoid arthritis, SLE and Sjogren's syndrome but it doesn't work for uveitis. enbrel which is a biological response modifier against the inflammatory TNF A, doesn't work in uveitis either but Remicade and humira do work in some individuals.

Durezol is pretty expensive, it is a steroid none the less with complications associated with it just as pred forte has. Pred forte works for most people however and It worked for me. Durezol does work faster than predforte requiring half the daily doseage with even better reduction of inflammation. Please see the announcement on DUREZOL with comment by the manufacturer that I posted. you might take the stuff to your opthalmologist for informational purposes for others who do have it in their insurance formulary.
the manufacturer is working very hard to get more plans to cover it and gives coupons for discount on the drug through opthalmologists offices.

you need to get an Optical Coherence Tomography done or a fluoroscein angiogram done of the back of the eye to make sure that Cystoid Macular Edema isn't present or vascularization of the chorid isn't occuring to explain your 'heartbeat' stuff for baseline as well as to rule out these other causes of visual disturbances that you mention. I had the 'looking through fanblades' like effect which was caused by CME. one opthalmologist told me it was the 'heartbeat' effect which proved to be incorrect. CME is caused by leaking blood vessels below the retina. the fluid accumulates and causes a pocket that separates the choroid from the macula. one can end up with a blind sport or epiretinal membranes over it.

wish you the best,
Mike
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Re: Isolating triggers for Iritis flare-ups

Postby SanDiegoIritis » Sat Apr 11, 2009 11:21 pm

Thanks again! I had the edema checked for on the last flare up and it was ruled out, so I was glad for that. I have noticed that at the end of my flare ups, I get this last sign of the inflammation of occasionally being able to see the inflmmation moving around, with the pulse, as opposed to a full smoke effect or looking through a sheer curtain.

Did you ever hear of Mobic used as a NSAID?

Judy
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Re: Isolating triggers for Iritis flare-ups

Postby Mike Bartolatz » Sun Apr 12, 2009 10:13 am

Some have taken it. I can't recall if it worked though.
did they do an OCT scan of your eyes to look deep into the surface of the retina. it works better in some ways than Idocyanine green Fluoroscein angiogram to do deep imaging study to see whats going on.

wish you the best,
mike
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Re: Isolating triggers for Iritis flare-ups

Postby SanDiegoIritis » Sun Apr 19, 2009 1:45 am

Yes, I had the scan last year and the retina is good. PHEW! I'm feeling good on this Mobic! Solving all kinds of aches I've had for awhile. I'm also switching Rheumatologists though, because I lost confidence in the last guy after that weird prescription. It will be interesting to see if the new doc sticks with Mobic or goes to one of the ones you list. The Iritis is also resolving, thank you God. I'm almost back to normal. It sure takes about a month out of your life!

Thanks, Judy
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