MS and Iritis

Post here with questions about other autoimmune diseases or conditions.

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Eyeslegs
Posts: 7
Joined: Mon May 28, 2012 11:17 am

MS and Iritis

Post by Eyeslegs » Tue Jul 24, 2012 10:27 am

Hi All, 

I posted this question over on the Introduce yourself forum and I'm not sure if this is correct procedure, but I'm sure one of you will tell me if I am wrong. I have copied my question along with Mike B's reply below, so you have the full story but I am still left with the question, how do I respond to my neuro, Do I get a new one, he has told me that Pars Planitis is related to MS but definitly not Iritis!!! This is really hard in the UK when we can't choose our medics. Please take a look below, I value all opinions.
Thanks, Pat

I have been reading a lot of great info on this forum and have come to realise that this is a great resource, so I thought I would join and ask some questions of my own. I'm not a very good forum person to be honest, since I work full time still and have disabilities to deal with and don't have much time to chip in but I will do my best to contribute.

Firstly, I have Multiple Sclerosis (MS), I was diagnosed with definite MS 5 years ago, although I had probably MS in 2003 and my first bout of Optic Neuritis in 1992. I would have been diagnosed much earlier had I had access to a good neurologist, and this last comment is what has led to my question below.

My main question is that I have just had my first bout of Iritis in the same eye that I had Optic Neuritis twice and actually totally lost my sight at the time of the ON for several weeks. I was also diagnosed with Convergence Disorder caused by the MS. When I was diagnosed with Iritis the Opthamologist said that he was not going to test for anything else since I had MS and I must be in an inflammatory stage of the MS which had caused the Iritis. My MS Nurse laughed when I told her and said they blame everything on MS once your diagnosed.

So next time I saw the opthamologist I told him of her reaction and he said, well she's a nurse, not a neurologist, maybe she doesn't know and you need to educate her. so I tried to tell her but she still insisted that no way was my Iritis related to the MS. So I asked my GP about this and he was astonished saying of course it is your MS, it's well documented. So he wrote to my neurologist to say so, my neurologist replied saying that the only the only type of Uveitis related to MS was Pars Planitis and no way was my Iritis related to the MS excepting that it was another inflammatory process.

Both me and my GP are confused and I have totally lost faith in my MS team. The research I have been able to find on this has been scanty and I am not sure how to approach this now as the MS team should be taking note of this relationship and documenting it in my records. 

Can you offer any advice please? I would be very grateful of any definite research links on his too.

Thanks Pat

any form of uveitis is DIRECTLY linked to MS. genes found in both conditions cause the inflammation present. anterior uveitis frequently occurrs as does posterior uveitis and Pan uveitis with inflammation throughout the eye. usually neovascualrization of the retina is more common in MS as is optic neuritis. overheating of nerves causes the temporary white out. this is called Uhthoff's sign or uhthoff's symptoms in MS. it can also impact legs for a couple of weeks too.
It amazes me how people get their heads stuck in old text books and continue to give patients erroneous information.
it is like asking which comes first, the chicken or the egg. often uveitis can preceed a given autoimmune disease by a decade or more or vice versa.
the main thing is to get an OCULAR IMMUNOLGIST involved early on to help prevent blinding consequences of a corticosteroid only approach to treatment. there is a list of these rare specialists available through the Ocular Immunology and Uveitis Foundation website http://www.uveitis.org in the PATIENT information section of the site. there is also a forum where you can ASK DR FOSTER A question forum. I suggest you ask this question of him. he is the TOP ocular Immunologist in the World. I also moderate forums for the Foundation. there is a lot of information at http://www.parsplanitis.org that you can read through on this topic.

I hope this helps,
Mike

Mike Bartolatz
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Joined: Fri Feb 06, 2004 9:58 pm

Re: MS and Iritis

Post by Mike Bartolatz » Tue Jul 24, 2012 1:03 pm

true experts in the diagnosis and treatment of uveitis will know that MS is linked to any form of uveitis, not just pars planitis. It has taken many neurologists a long time to recognize there is ANY link to uveitis and MS. Pars planitis wasn't recognized until just a few years ago ( I have pars planitis and have undifferentiated lesions on my brain) Professor William Ayliffe in London is an Ocular Immunologist and will be able to work with you on this. you can email him directly through his contact information at http://www.uveitis.org in the PATIENT information section of the site. there are other ocular immunologists in the UK who can also work with you if you can get your doctor to refer you to them. Professor Ayliffe does take patients privately if needed. there are several other conditions that can be mistaken for MS that also cause uveitis. one of these experts might be able to help you to confirm that it is indeed MS present or suggest an alternative diagnosis. frequently Sarcoidosis has lesions on the brain or spine that can mimic MS for example.
there are about 5 specialists in the UK, Ireland and Scotland on the list of specialists. some have email addresses that you can send a note to about your care. you can also ASK DR FOSTER a question at his forum at the above link as well.

wishing you the very best,
Mike
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Eyeslegs
Posts: 7
Joined: Mon May 28, 2012 11:17 am

Re: MS and Iritis

Post by Eyeslegs » Wed Jul 25, 2012 3:01 am

Thanks Mike I truly appreciate your reply, however on one point it is definitly MS I have as my brain and spinal lesions are a typical MS pattern and I have had other relapses and signs indicative of MS. My sister is also diagnosed. I will look up the UK guy though and chat to my doctor. Just one thought, as I have only had Iritis once and it has cleared at he moment, although I have residual eyes issues relating to ON too, should I leave this to see if it is going to recur first? Surely it isn't chronic unless it returns?

By the way, I did ask Dr Foster as you suggested by his rep,y put a whole new slant on this so I have copied it below for you to see.

Thanks again.
Kind Regards
Pat

Sure. My first advice is to not lose faith in those who are caring well for you; it sounds as if your MS is well cared for. Second, it is possible that your uveitis is secondary to MS, even if it is not pars planitis. No one knows everything. If you have retinal vasculitis on fluorescein angiography, then I am inclined to blame the MS; that still leaves you and your doctors with the matter of what to do for you in the way of therapy, and steroids is not the appropriate answer. Third, it is ENTIRELY possible that you now have a second, unrelated autoimmune disease, i.e., autoimmune uveitis. People who have one autoimmune disease (eg, MS) are much more likely to develope a second autoimmune disease than some randomely selected person from the general population is likely to. Thus, you deserve a thorough investigation, AS IF you had no MS and came to the doctor with uveitis.

Mike Bartolatz
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Joined: Fri Feb 06, 2004 9:58 pm

Re: MS and Iritis

Post by Mike Bartolatz » Wed Jul 25, 2012 9:24 am

that is what I was trying to tell you, that other things can present along with MS for example to include Sarcoidosis. I know several individuals witha diagnosis of both conditions at the the Sarcoidosis support forum at inspire.com at the foundation for sarcoidosis research here in the USA.

I do hope that the iritis doesn't return for you but be vigilant watching for increase of floaters and reduced vision, photophobia etc as they can by symptoms of both conditions not just optic neuritis and get in to be checked out. have they done a depressed scleral exam looking for pars planitis? this is a bit different than a regular exam through the slit lamp microscope, the push in on the sclera just adjacent to the iris so that they can see the pars plana just behind the iris and ciliary body while looking through a hand held prism and a head lamp? an increase of floaters can be from bleeding from the retina as well as from uveitis. watch for flashing lights too as that can be a symptom of a detaching retina as well as from optic neuritis.

wish you the best,
Mike
Mike Bartolatz
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Eyeslegs
Posts: 7
Joined: Mon May 28, 2012 11:17 am

Re: MS and Iritis

Post by Eyeslegs » Wed Jul 25, 2012 1:29 pm

Thank you very much this is all invaluable.

Best Wishes
Pat

Mike Bartolatz
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Re: MS and Iritis

Post by Mike Bartolatz » Wed Jul 25, 2012 2:22 pm

Pat,
keep me posted please.

take care,
Mike
Mike Bartolatz
Moderator

Eyeslegs
Posts: 7
Joined: Mon May 28, 2012 11:17 am

Re: MS and Iritis

Post by Eyeslegs » Wed Dec 12, 2012 12:42 pm

Hi Mike,
Thought I would update you on my current situation. I have not had any recurrence of Iritis, but finally got to see an Opthamologist again today as my eye issues continue. Outcome of today's appointment:

my eyes are physically in good health although there is some pigment dispersion present, this is the first time that was mentioned to me, there are more cells present in the left eye which is the one I had ON and Iritis in.

All other symptoms are probably caused my my 'misfiring nerves' and 'damaged optic nerve'. So probably MS causing it as I have a definite diagnosis but it is unlikely to be documented anywhere!

My Convergence Insufficiency is worse and I have been given exercises to do and will see an Optometrist to discuss prisms to help.

Any thoughts on this?

Mike Bartolatz
Posts: 6595
Joined: Fri Feb 06, 2004 9:58 pm

Re: MS and Iritis

Post by Mike Bartolatz » Wed Dec 12, 2012 10:11 pm

I know several individuals who had to have prisms made for them because of problems like yours associated with various autoimmune diseases including MS. they swear by them but as with everything you have to get a real expert to make them for you. not normally made by local opticians but are sometimes co located with major vision centers affiliated with teaching hospitals. some universities have them.
pigment dispersion might indicated that you don't have uveitis going on. it takes a lot of experience to make this type of diagnosis. did they mention any signs of past exudate or snowbanking along the pars plana just behind the iris? often intermediate uveitis is linked to MS. how about signs of vascularization of the retina or Cystoid macular edema?

what MS meds are you on? I have a friend with pars planitis just recently diagnosed with MS who is on one of the 'abc' drugs, can't recall which one off hand. he posts to the http://www.uosg.org site. his name is dave. I suggest you join that group and I'll greet you there and will hook you up with Dave to chat with. He goes to John's Hopkins in Baltimore and sees Dr Quan Nguyen who is an ocular imunoloigist and a retina specialist.

wishing you all good things this Christmas and New Year too!
Mike
Mike Bartolatz
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Eyeslegs
Posts: 7
Joined: Mon May 28, 2012 11:17 am

Re: MS and Iritis

Post by Eyeslegs » Thu Dec 13, 2012 4:20 am

Thanks Mike, I will pop over and take a look and no nothing else was mentioned at all.

You have a great Christmas too.

Pat

Eyeslegs
Posts: 7
Joined: Mon May 28, 2012 11:17 am

Re: MS and Iritis

Post by Eyeslegs » Thu Dec 13, 2012 4:31 am

Already a member there Mike, which forum should I be looking at?

Thanks
Pat

Mike Bartolatz
Posts: 6595
Joined: Fri Feb 06, 2004 9:58 pm

Re: MS and Iritis

Post by Mike Bartolatz » Fri Dec 14, 2012 10:40 am

http://www.uosg.org support forum
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