Dose NSAID treatment really work

[Scotty P]

elcome to the group.
HLA B27 uveitis is autoimmune in nature, the immune system has to be treated systemically in order to stop the recurrent nature of the beast. oral non steroidal anti inflammatory medications can break this cycle by retraining your immune system to stop attacking your eyes by mistake. because of the long time that you have had a history of uveitis it might require Disease Modifying Anti Rheumatic DRugs such as Methotrexate, Cellcept etc to get you to a poing of off all steroids without inflammation. as mentioned to others, a six month trial would usually determine if this can be accomplished with NSAIDs for you. if you remain off steroid without inflammation you would continue on the NSAID at prescription strenght for two years, then taper off . here in the USA, celcept, Difusinal, Indomethacin ER and Naprosyn are all used effectively to stop autoimmune uveitis. in your type of uveitis, NSAIDs work in about 60 - 70 % of uveitis patients.

thats one hell of allot of steroid to put in your eyes. over time you may well develop cataracts and even glaucoma from chronic steroid use. after about 850 drops cataract often starts to develop. the disease can also cause cataract to form as well as glaucoma to develop. most vision loss is from complications to these things.

Hi Mike,

Thanks for the prompt reply. Yes i do have the risk of contracting cataracts and even glaucoma due to the large amount of steroids, i have had literally thousands of drops over the years. Yesterday 29th of April 09 i had one of my many check ups with my specialist, i mentioned the NSAID treatment and she actually said it dose not work. She then went on to tell me that she was one of the doctors involved in the trial for NASAID. She did also say that this particular trial was aimed at people specifically with the HLA B27 + gene. I was just wondering what information you have to prove that this treatment has worked as i am interested in it. I would like to go back to my doctor with some evidence.

Thanks again.
Scott

[Mike Bartolatz]

Doctor Foster at the Ocular Immunology and Uveitis Foundation has indicated that he has about a 60 to 70 % success rate with use of NSAID therapy in non granulomatus autoimmune uveitis (HLA B27) with the use of Celebrex, dolobid (Difusinal), Naprosyn or Indomethacin in his patients. he is the Foremost Ocular Immunologist in the World. you can go to his site at http//www.uveitis.org and search his professional section on NSAIDs and uveitis.
his treatment algorithm's next step after steroid failure to stop autoimmune uveitis is a trial of Celebrex for six months to see if an off all steroid without inflammation situation can be achieved. if this cannot be accomplished he moves on to DMARD drugs such as Methotrexate alone or in combination with other meds often keeping Celebrex with it initially and then adding other drugs if need to accomplish the off all steroids without inflammation position.

wish you the best,
Mike

[Scotty P]

Hello Mike, sorry for the extremely delayed response.

Doctor Foster at the Ocular Immunology and Uveitis Foundation has indicated that he has about a 60 to 70 % success rate with use of NSAID therapy in non granulomatus autoimmune uveitis (HLA B27)

Am i correct in saying that this is specific for non HLA B27+ uveitus? I'm a little confused.

You mentioned that after about 850 drops cataract often starts to develop, I've literally had tens of thousands of drops and have had no problems so far. Now with the NSAIDs treatment aren't you replacing one problem with another in regards to long term use and side effects? Is the whole point of NSAIDs used to get you off the steroidal drops? With possible side effects such as Liver damage, Lung damage, Male fertility (drop in sperm count) and gut and bowl issues and manny more you get with the drugs you mentioned above. I think it would be unwise to damage your body further with this method of treatment, now these are all POSSIBLE side effects some people may have none. However would this not be a catch 22 scenario? (trade one long term side effect for another)

[Scotty P]

Sorry one last thing, my doctor has asked me wether or not anything has been Published in regards to the NSAID treatment. As mentioned she was involved in the trial specifically HLA B27+ related uveitis and it was deemed to be unsuccessful.

[mtbargeman]

Scotty-

NSAID treatment does have side effects for some people. I have to admit i have never heard of male fertility issues with it, however, I would think that the sperm count would come back up if the patient tapered off the drug for awhile. As for stomach/bowel problems with NSAID use, your doc can give you another medication, such as Protonix (my fave- prone to stomach ulcers), and it will counteract the stomach/bowel issues.
Nsaid treatment reduces inflammation in the eyes; inflammation is the key problem here. You need to get the inflammation under control in order to save your vision. If you can keep from losing vision to the complications of Uveitis as well as the Uveitis itself, the NSAID therapy is worth it.After losing vision to high IOP due to steroid drops, complications from under treatment, etc, finally being legally blind, I can tell you that you want to save your vision. If you don't save your vision, you don't save your freedom and independence.

Good Luck.
Mary

[Mike Bartolatz]

I suggest that you go to http://www.uveitis.org and address these issues with Dr Foster, the TOP uveitis specialist in the World who has a 70% success rate of NSAID therapy in HLA B27 related uveitis. He developed the 'step ladder' approach to treatment of autoimmune uveitis over the past 30 years pioneering MODERN treatment of Ocular Inflammatory Disease processes along with Dr Nussenblatt at the National Institute of Health of the USA and other top specialists around the USA and Europe. He teaches this through the American Academy of Opthalmology in Continuing Medical Education Courses along with Dr Nussenblatt, Van Gelder, Rao, Vangelder etc annually at changing locations so that opthalmologists can learn MODERN treatment of this stuff. I don't know who your specialist is, but whomever it is, he/she, should be aware of who DR Foster is in the World of Opthalmology. She can go to his site and ask him personally if she so chooses to learn about this type of treatment. For some, no amount of information is enough relying solely on steroids for care.
if you choose to employ a steroid only approach and you are happy with it, then continue as I will never convince you that over time, steroids can do allot of harm to the eye as well as to other body systems. cataract formation as well as glaucoma are listed side effects of steroid eyedrops. they can weaken blood vessels of the eye too and cause tissue damage.
oral steroids can do this as well and can also cause type II diabetes, bone loss and tissue necrosis as can injectible steroids.
I am NOT saying that they don't have a place in treatment of uveitis. they are the mainstay of stopping severe inflammation but their sytemic effects are cumulative leading to problems. this is recognized by rheumatologists treating arthritis patients as well and pulmonary specialists treating lung disease and neurologists treating neurological conditions too.


wish you the very best,
Mike

[vancouver]

http://www.healio.com/ophthalmology/ret ... most-cases

After 15 yrs it seems only Dr foster is fan of oral nsaids.
I have not found the study that says oral nsaids don't work.

[vancouver]

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[vancouver]

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