Flare up in 1st trimester of pregnancy

[meikog]

I have not posted in a long time. Since my last post I had a ct scan of my spine and the diagnosis of AS was false. So that was great news. I had not taken anything for iritis or arthritis prevention since December of 2009. In September of 2010 I got pregnant. During those 9 months I had one flare up. I opted for an injection and pred forte drops. During my pregnancy I did not have a flare up at all. After my daughter was born I experienced about 6 flare ups. This was during a span of about 8 months. I am now pregnant again. Right at the beginning of my pregnancy I was in the middle of a flare. It went away with Durezol drops. That was about 4-6 weeks ago. I am having another flare and am also now experiencing arthritis,'which usually happens when I have a flare. I am concerned and confused, as I thought during pregnancy your immune system is lowered and the chance of a flare was greatly reduced.

Should I expect to get more flares during my pregnancy? Also, I am worried about getting a lot of flares after the baby is born. I used to average about one to two flares every 12-18 months. Now it seems like I am getting them every 2 months or so. I should also add that I am HLA B27 pos.

Thanks for any insight you may have.

[Mike Bartolatz]

frequently women flare in the first trimester, then by the third their eyes quiet down but then the iritis comes back with a vengance a few weeks after the baby is born. you might need a close section scam with contrast of the lower lumbar region and the bones of your pelvis to see image joint damage. one can also have pain from enthesis where ligaments and tendons attach to bones causing low back and other joint type pain. HLA B27 is a strange beast and the thing can be difficult to 'name' as what is causing what. the main thing is once the baby is born and you are no longer breast feeding, get to an EXPERT and start a steroid sparing approach to treatment. the steroid rollercoaster is with you forever if you don't do this. your eyes will probably develop cataracts and other complications to the retina over time. the disease can cause this to and Glaucoma often develops with steroid use or the disease plugging the drains inside of the eyes. membranes with new blood vessels can grow over the retina called neovascular membranes occur which can bleed. there can also be pockets of fluid that build up under the retina called Cystoid maclar edema that can cause blind spots or detacment of the retina.
you might also have other Complaints of the GI tract from ulcerative colitis, crohn's disease,
watch for various rashes too as they occur with Crohn's disease and also with Psoriasis/psoriatic arthritis also linked to the HLA B27 gene
if things are 'granulomatus' rashes, then Crohn's disease might be the culprit. Scalely rash is with Psoriatic arthritis and this causes swelling of the big toe or the index finger, nails can be darkened too.

Take care,
Mike

[meikog]

I believe the ct scan was of my hips joints and lower lumbar. I will ask my uncle, he is a radiologist and did the scan for me.

My biggest concern is complications with my vision, and possible vision loss. I have had a lot of issues with discharge in the the right eye, which is the eye that always gets inflamed. My ophthalmologist said this is from clogged tear ducts, I also get a lot of styes now in that eye. I never had these issues before my first steroid injection.

So far I only have arthritis pain in my hands, feet, and knees. The pain usually occurs when I am sick, which has been a lot in the last year, or when I have a flare up.

What would you recommend for a steroid sparing treatment? I was on Enbrel for a few years, but it didn't seem to help keep the iritis from flaring. It only helped with the arthritis.

Thank you for the input and support. This has been a very painful and frustrating year.

[Mike Bartolatz]

yes you should be concerned about long term consequences of recurrent or chronic uveitis treated only with steroids. the ENBREL doesn't work for uveitis. this has been known for about 10 years now. you start with DMARD drugs first such as Methotrexate, Cellcept Or Imuran and increase dose until you eyes are quiet, then you taper the steroids until you get to 'off all steroids without inflammation'. sometimes A biological response modifier in the same class as the enbrel has to be added to the mix such as Remicade or Humira. these two TNF A blocking drugs work the best.

you may well have psoriatic arthritis with the hand arthritis and HLA B27. or you may have the IL1B gene present which causes Osteoarthritis of the hand in some individuals. this is often seen along with Sarcoidosis and Type II diabetes.
it could also explain why you have no arthritis of the lower lumbar spine. Psoriatic arthritis can cause cervical spine fusion so you might want to get this checked out by your relative the radiologist.

you can also try NSAID therapy for HLA B27 related uveitis and it will also help with inflammation of arthritis. DR Foster uses prescription strength Celebrex, Difusinal or Naproxen, the last two are generic and Naproxen is available OTC but it has to be watched as do all of these drugs to make sure they are not causing systemic problems especially of the liver, kidneys, stomach and heart etc.

now lets address the blepharitis and dry eyes that you have. dry eyes must be treated before it causes damage to the conjunctiva. this results in abrasion of the sclera and the cornea when you blink. the damaged conjunctiva allows pathogens kept out of the eye by a healthy conjunctival membrane to cause problems with the cornea and the sclera. this is very serious as it can cause the sclera to require a graft or the cornea to require a transplant.

mix a solution of very warm baby shampoo and water and then wash along the lash line of your eyes with a gentle massaging action. get some lubricating eyedrops and put a drop in your eye before you do this as the meibomian glands that are plugged up in the eyelash line will secrete a 'plug' and it can mix with the lubricating eyedrop and help lubricate your eyes. do this about 4 times a day.
get some very good quality lubricating eyedrops such as theratears lubricating eyedrops and put them in your eyes periodically during the daytime. put a drop in before bedtime, if you have to get up to put drops in, switch to a gel type lubricating eyedrop at bedtime. this is what I have to do,you may also notice that your eyes blur while on the computer, we forget to blin so make an effort to do this and you will see better.

I am concerned about the 'discharge' as it might be infection rather than just a plugged up punctum.
the styes could be caused by a bacteria that causes acne that all of us have. this can go haywire in some people and cause problems in Sarcoidosis patients. granulomatus uveitis occurs in Sarcoidosis and granulomas can occur on your legs, skin, lungs and just about any organ of the body. not saying you have this but mention it in passing a one of the causes of iritis and other forms of eye inflammation.

I hope this helps,
Mike

[Mike Bartolatz]

you might consider getting an ocular immunogist involved in your care. they are aware of which drugs work and which ones don't in treating uveitis. there is a list of them at http://www.uveitis.org in the PATIENT information section of the site. you have to get this stuff controlled once your child is born.

take care,
Mike