Any luck with Naproxen?

[Lulu]

Any luck with Naproxen?
Hi, well, the kenalg injections bought me about 6 weeks of quiet this fall and then my left and then my right eye flared up and are still flaring. I've been told to take naproxen 500 mg twice a day and if that doesn't help get me off steroids, then Dr. Hinkle reccommends methotrexate. I was wondering if anyone has had any success with Naproxen (advil didn;t do anything but take away the pain). I tested negative for all the other systemic causes of iritis. The opthamologist that I see regularly thinks that with my history of ping-ponging intractable iritis, it's going to take something stronger than an nsaid to get this iritis under control. This talk of serious drugs is actually freaking me out more than iritis.

[Mike Bartolatz]

Hi lulu,
did you test negative for the HLA B27 gene? iritis that ping pongs between eyes is often related to it. Dr Foster has about a 75 percent success rate in autoimmune related uveitis when Naproxen, Cellebrex or Dolobid are used in a steroid sparing approach. it will take about six months to know if this will be the case for you.
the DMARD drug Methotrexate has a very good safety record with no more chance of serious consequences than the general population. if your liver or kidney function tests become abnormal from it, the doctor will stop it and select another med such as Cellcept etc. sometimes nausea is a complaint with MTX so the med Zofran can calm it down. an Iron supplement should be taken about 11 hours after taking the MTX. usually people take MTX the night before the weekend so that they can see if they will have this problem. often it subsides after the second or third week of treatment. fatigue can be a complaint as well.
you are very fortunate to have Dr Hinkle and DR Foster at Mersi there in Cambridge as your specialists. DR Foster is the very best in the World at getting people to remission from all forms of Ocular Inflammatory Disease.
I also help with his support network. he has his site at http://www.uveitis.org and also has an online support group at http://www.UOSG.org and I administer the http://www.parsplanitisforum.yuku.com site for the Ocular immunology and Uveitis Foundation that Dr Foster developed.

Please ask any questions that may arise as nothing is too trivial to ask. also please know that you are NOT ALONE1
wishing you the very best,
Mike Bartolatz

[Lulu]

Hi Mike, thank you for the thoughtful reply.
I did test neg for HLA B27.
My last flare up they put me on durezol and my pressure went to 40, so they tapered me off on pred forte m which hasn't caused pressure probs for me in the past. I didn't take the alphagan drops for the pressure b/c of side effects, but I assumed that the pressure would go down since I stopped the durezol. Ia m a terrible patient, I know--i am just sucha chicken when it comes to side effects.

About 8 days ago I started the naproxen regimen--440 mg every 12 hours. On the positive side, i have found that the brand name stuff does not cause me any heartburn. When I tried taking the generic stuff a few months ago I got terrible heartburn right away.

Yesterday I woke up with my left eye red and blurred vision, but no pain. Today, same thing. I think I must be flaring and the naproxen is just masking the pain. I didn't start drops because i have had a cold and was hoping maybe i got pink eye somehow, though now i am pretty sure it is a flare since I have no other pink eye symptoms. I am going to the eye specialist tomorrow to get checked. I was wondering if you know if this flare means the naproxen just doesn't work for me or if it might take more time to tell? i am just so afraid of going on methotrexate. i take care of my two little girls full time and am worried about side effects making it impossible to be home with them full time.
Thanks again for all your help., Mike. It is a real morale lifter to have this site and you as support dealing with this condition (One year with no more than 7 weeks between flare ups).

[Mike Bartolatz]

it can take up to about 6 month on NSAID therapy in order to know if it will work for you. I am concerned about you elevated IOP which has to be treated or it will rob you of vision, possibly blindness if not treated. it is the primary reason for permanent vision loss after which Cystoid macular edema and detachment of the retina or vascularization of the retina are next.

many individuals have no problem at all with taking methotrexate for your information. if it does cause allot of nausea, then switching to Cellcept can be done or other drugs. there is no need whatsoever to use a medication that makes you 'sick'.
the main thing is to find something that will work for you to get you off all steroids without inflammation.

I am glad that you have found support here to be helpful. Please know that we will do our very best to help you through this.

wishing you the very best,
mike

[Lulu]

Thank you. My IOP was 30 for both eyes today so I started the Alphagan. SO far it isn't bothering me (and I was quite amazed that it got rid of the redness immediately). My left eye was "+ 3 1/2" today and my right was a +plus 1, so I am back on pred drops. He's going to give it a little more time to see if the Naproxen will work--he thinks with my history I really will need methotrexate. Dr. Hinkle will discuss this with me more fully at my appt in four weeks when he has office hours here in Albany. I think i am starting to finally come to terms with this. I have known intellectually that I needed to get off steroids, but I think i am finally ready to accept it.

[Mike Bartolatz]

please do as DR Foster and Dr Hinkle suggest as they are the best team in the World for this stuff. those pressures are getting a bit high. is it from the steroids or have the angles or trabecular meshwork been blocked by debris from the inflammation? your inflammation is pretty high at 3 1/2. I hope the pred forte works well for you. did you try Vexol at any point instead of the durezol or pred forte? I know Dr Foster prescribes it quite often as it doesn't require shaking and the preservative isn't doesn't cause ocular allergy over time.

I hope the NSAIDs work for you but going to a DMARD drug such as Methotrexate or Cellcept works very well to quiet the eyes down. there are other options regarding meds if required later on too.

wish you the very best,
Mike