NSAID in iritis + MTX and future pregnancy

[gonzinka]

Hello.

Thank you very much for answering me in the intruduction section. I went to see my eye doctor today and asked him for Celebrex. He said that I should talk about it with my rheumatologist. I am going to see the rheumatologist in two weeks, but my question is - can I use Movalis 15 mg once a day (meloxicam) instead for the next two weeks? I have it at home and I was supposed to use it in case of back pain (which I don't have). Has anybody tried this medicine or knows the dosage in iritis?

My eye doctor has decided to change the TobraDex drops into Yellox drops, as my left eye seems peaceful at the moment. He told me to take Yellox into both eyes - and that's a little strange, but I'll do it.

This forum is so valuable! In Poland doctors seem to treat patients chaotically. It's here that I've read that Methotrexate means 2 years commitment. Doctors here didn't know, and I've seen many, inluding country-famous rheumatologists...

My second question is abuot Methotrexate. Doctors here are not 100% sure if it is safe for women to take MTX before becoming a mother. Some say it's ok, some say it's not a good idea to try. Has anybody here taken it and then quit it and got pregnant? I'm asking because I'm 32 soon, I want to have a kid in the future. Iritis makes my life so miserable (I used to work as a graphic designer... been sick for a year now, lost my job...) and maybe I shouldn't try NSAID... Maybe it's high time to make the MTX commitment... start working again... and then think of a child... Oh well...

OK, I hope that someone can help me with my questions. Thank you Mike for your answers so far. I guess I should forget about contact lenses forever

Natalia

[Mike Bartolatz]

If I were you I would take Cellebrex, difusinal or naproxen which are NSAIDS before trying Methotrexate as Dr Foster uses a step ladder approach to treatment. about 70% of his HLA B27 positive patients respond to NSAID therapy given at Prescription strength. I don't know if Meloxicam is useful. I know that Ibuprofen isn't as good as the ones I've mentioned above. you can ask Dr Foster at http://www.uveitis.org and you can interact with others on NSAID and DMARD drugs at http://www.uosg.org another online support group that I help out with.

I would NEVER get refractive surgery but contacts can be used as long as the eye is well hydrated and not infected. if you wear contacts, change them regularly, dispose of any wetting solutions or cleaning solutions and cases after about 3 months. also throw away eye makeup after 3 months too and get new stuff. you can take Methotrexate but you must stop it about 6 months prior to trying to conceive if I recall correctly.

wishing you quiet eyes,
Mike

[gonzinka]

Hello Mike nad everybody.

I am so grateful for this forum, but sadly it shows how little doctors here know.

Well, as I'm waiting for my rheumatologist appointment in 2 weeks, my eye doctor wanted to try switching TobraDex twice a day into Yellox (bromfenac) twice a day, as my eye was quiet. I've read that bromfenac doesn't help with uveitis, but it can prevent the flare-ups in some cases. Well, I guess I'm not that case: after only a day my eye got reddish. I've dilated it with Atropinum... and feeling so deppressed right now. My doctor told me to use Yellox until our next appointment on Wednesday, April 18th - not to panic, just keep using it. He's not available sooner. And that makes me pretty anxious, I want to start using TobraDex again, I don't want to get lymph again... Mike what would be your suggestion on this? Because I'm about going back to TobraDex... I know and fully understand it is only my decision if I don't feel like doing what my doctor told me... I just feel that I don't want my eye to get worse... to get back to the stage that I even can't use computer and have this huge, unbearable light sesivity...

So, here's my another question. When you use Cellebrex, how long do you have to take it to go off the steroid drops? I will definitely bring this subject to my rheumatologist in two weeks, but I guess it may be too late for me - I've been having this chronic case of inflammation in the left eye for over a year now.

(I didn't mentioned it before: for 6 months I didn't eat wheat or meat at all and succeeded in getting of steroid drops. My left eye was ok for 1,5 months. I started to eat wheat and meat again and the inflammation came back. I'm not sure if that might have been connected... Oh, well.)

[Mike Bartolatz]

I am not a doctor so this is difficult to answer. USUALLY one goes on the NSAID at prescription strength while tapering the corticosteroids. you should know within 3 to six months if you can be at 'off all steroids without inflammation'. then you would continue on the NSAID for TWO YEARS and then SLOWLY taper off the NSAID, Methotrexate is done the same way. in the beginning with the DMARD drug you would keep adding to the MTX until you got to 'off all steroid without inflammation'. and it would also go for TWO YEARS until a slow taper is tried.

the bromfenac will help with CME if present but it won't help with uveitis from what I have been told by C Stephen Foster MD the top Ocular immunologist here in the USA and perhaps the World.

you should be taking a corticosteroid like predforte or it's equivalent with active inflammation. a short trial of Durezol could also be tried but you cannot be on this for more than 2 weeks at a time because it can elevate pressure dramatically.
injection to tissue surrounding the eye can also be done to quiet the inflammation but use a short acting corticosteroid as you alread have pressure problems.

you asked about Methotrexate and you must be off it for at least SIX MONTHS before trying to conceive from what I have read but this has to be approved by your medical team there in Poland.
get the darkest pair of POLARIZED sunglasses you can find that wrap around and fit snuggly to the face to help with the photophobia, aversion to light. your optic nerve may be inflammed causing this or your cornea.
have you been examined for a possible Herpes Simplex or Herpes Zoster infection? this impacts one eye and has a lot of synechiae and can cause severe elevated pressure inside the eye. if this is a possibility then you would be on a drug like Acyclovir a anti viral medication at full dose for a very long time and one drop of predforte (prednisilone acetate 1% ophthalmic topical eyedrop) a day. if you get a generic equivalent for Pred Forte, it has to be shaken for a minimum of 3 minutes to get it properly suspended in solution. in England they use Maxidex a lot.

with lymph gland involvement have you been tested for Sarcoidoisis, systemic Lupus Erythematosus etc?

wear your sunglasses while inside and while on the computer. I personally use brown tinted 'fit over' your glasses sunglasses because I have to wear glasses to correct for my Intra Ocular Lens Implants put in after cataract surgery. there was so much debris in my eyes that the measurement was not acurate for the IOL"s. one was also Torn in the shipping vial so they had to use someone elses lens to be implanted into them at a later date on me.

Sporting goods stores often have the Fit over sunglasses. motor cylce shops also have them and most pharmacies have them. sometimes they are located with regular sunglasses, they also make Goggles to keep wind out or dust out that have interchangeable lenses. some sunglasses have these too.

I hope this helps,
Mike Bartolatz

[Mike Bartolatz]

if you are allergic to anything then that can trigger production of inflammatory cytokines such as IL17A which cause inflammation inside the eye and which also triggers production of TNF A found in many disease processes including uveitis. if NSAIDs or DMARD drugs don't work, then A TNF A blocking drug would be added to the methotrexate, Cellcept or Imuran.
do you have any skin rashes present? any arthritis? do any of your family members have rashes as found in Sarcoidosis, Crohn's disease, Lyme disease ( don't know if this is found in Poland) Systemic Lupus Erythematosus, rheumatoid arthritis etc?

Wish you the best,
mike Bartolatz

[Mike Bartolatz]

http://askcsf.yuku.com/topic/2394/Stero ... -remission

[gonzinka]

Hello Mike,

Well, doctors here claim that my iritis is connected to the spondyloarthropathy. I was diagnosed with Ankylosing Spondylitis a few months ago (HLA B27+) - my father's brother has it. But I may have as well Psoriatic Arthritis (HLA Cw6+). One doctor suggested the Reactive Arthritis, as my iritis is - as far as I can tell - connected to the bladder inflammations I happen to have. Doctors say that those diseases are treated the same way anyway. I also wait for the results of my second blood work done for the Lyme Disease - the first one was positive and needed to be double-checked with the Western Blot method.

As to the herpes simplex. I sometimes have it on my mouth... Can it be connected to the eye? I've never ever heard about something like that.

The lymph gland - I guess I wrote something wrong in my last message (forgive my English). What I meant was the... exudation... (?) can't find that one in the glossary of terms Well... In iritis you have to dilate your pupil, because otherwise the inflammation may become so huge, that... there may be adhesion between the iris and the lens... Well, I was told by the doctor that many cells mean a kind of fluid... I guess... And that fluid causes the adhesion. Nevermind It probably has its name but I just don't know it yet

My IOP (eye pressure) is fine - 15.1 mmHg in the right eye that is inflammation free, and 10.0 mmHg in the left eye that is chronically inflammated.

I am on the Bromfenac drops for the 4th day now and my eye is more and more reddish. Fortunately I'm seeing my eye doctor tomorrow

[Mike Bartolatz]

being positive for HLA B27 and cw6 makes it possible that you will develop Psoriatic arthritis.
another marker found is IL23R and ERAP1 which are linked to ankylosing spondylitis, psoriatic arthritis, crohn's disease, autoimmune thyroid disease, systemic Lupus Erythematosus and rarely breast cancer.
you might ask to be checked for these discovered in 2007 and confirmed by others. IL1R2 and ANTXR2 are also found in seronegative spondyloarthropathies.

Synechiae (Sneek E eye) are adhesion's between the iris and lens. they are pus like cells that glue them together. herpes sx often causes problems with the surface of the eye but it can also go up a nerve and into the eye and cause iritis. with this there is a major increase of pressure from almost 360 degrees of adhesion between the iris and lens. the virus attacks the ciliary body and the muscle that opens and closes the eye becomes paralyzed

exudate is usually along the pars plana and the posterior retina. when on along the Pars Plana, a small amount of exudate is called a snowball, a lot of exudate forms a snowbank