Iritis and hlab27

[Kellibk]

I am a 35 year old female with 3 bouts of confirmed iritis. I had 1 episode about 8 years ago. The eye doc sent me to my general doctor to get some lab work done and it was confirmed I have the HLAB27 gene. I also went to a rhemutalogist and my physcial exam was normal. Everything has been quiet until this past December. It took about 3 months for it to finally get better with the steroid drops. 4-5 days after I was done with treatment I felt it flaring up again. I thought maybe I was crazy because I just finished the drops and was so happy to be done. In the meantime the doc took xrays (which were -) and did some lab work for lupus and other disorders. All came back negative. She did refer me to a rhemutalogist too but have not had a chance to go back. I don't have any arthritis pain. I have also had 3 cold sores in the last 3 months also. Don't know if this is related but does seem strange. I have had cold sores in the past but only like once a year. Everytime I try to wean my pred. drops it seems to get worse.

Any thoughts or comments are appreciated.

Thanks
Kelli

[Mike Bartolatz]

Kell,
welcome to the group!
your iritis could be linked to the cold sores independently from the HLA B27 gene. only a skilled ophthalmologist can determine what is going on but it is CRITICAL to get this checked out as treatment is different. if the herpes sx virus is the cause which causes the cold sores, then antiviral meds need to be taken right away. this virus can get to the back of the eye and can cause Acute Retinal Necrosis, ARN. not good to say the least. when one has iritis from this cause, there is a lot of adhesion between the iris and the lens, pressure goes up right away in the eye.

there can be a lot of inflammation associated with HLA B27 uveitis too. it can 'ping pong' between eyes. you put out the fire with eyedrops and it starts up in the other eye and back and forth it goes.
Often adding an NSAID such as Celebrex, dolobid or Naproxen taken at prescription strength breaks the recurrent nature of this type of iritis. if you start now you would know in about six months if it will quiet the eye down. the goal is off all steroids without inflammation. if adding the NSAID doesn't work within Six months, you would need to then move on to DMARD drugs such as Methotrexate, Cellcept or Imuran.

I hope this helps,
Mike

[Kellibk]

Thanks for all the valuable information! Greatly appreciated:)

My pressure has always been normal but I didn't bring up the cold sores to the doctor. I am thinking of getting a second opinion because my doctor thinks the drops are the only option. I see there is another specialist in sun city arizona that I may give a try. Looks like she specializes in uveitis.

It is starting to really get me down. I definitely want to get a handle on it because it affects my lifestyle I have 2 children and seem to always have a headache from the eye pain.

I have been taking naproxen for a few weeks

Thanks again

Kelli

[Mike Bartolatz]

please get a doctor involved with taking the NSAID. it can cause problems with your liver, kidneys and even your heart (all nsaids cause these things) so you will need to get periodic testing while on them to make sure they are not causing problems.
if you can get your eyes quiet on the NSAiD, then you would stay on it for TWO YEARS before tapering off of it. it would be taken at prescription strength not the OTC dosing.

the closest experts are Dr Rao at Doheny eye institute in LA and DR Vitale in salt Lake city. there are a couple in Littleton Colorado too trained by DR Foster at Harvard.

yes this stuff is problematic. I had brow pain and temporal headache with uveitis.

take care,
mike

[Kellibk]

Ok Thanks!

Would you reccomend Mandi Conway in Sun City, AZ too?

Thanks,

Kelli

[Mike Bartolatz]

I know nothing about the doctor. there is a doctor at the university there in Arizona that you could try but the best specialist near you are in California, Utah and Colorado.

wish you the best,
mike

[Kellibk]

Hi,

I have been fighting iritis since January this year. I am hlab27 positive. xray - for alk. spon with no back pain. Everytime I try to wean the drops it seems to reflare. They did culture my eye back in May and it was negative for the herpes. I do take naproxen everyday to help with immflamation. This last episode I wasn't responding to pred fort every hour so my doctor switched to durezol every hour. It took a few weeks to get it under control. As soon as I started to wean I started getting my headaches again. I had my scheduled appt and at that time I had trace cells. I increased to every 3 hours and over the weekend it seems to be getting worse. Now I am doing the drops every hour again. My doctor in AZ doesn't seem to have any more options than the steriod shot in the eye. This was his next step if the durezol did not get it under control.

You mentioned a specialist at the University of Arizona? Do you mind sending me his name. Looks like we may have to make a trip to CA or CO to get better treatment.

Also, do you think I would benefit from methotrexate?

Thanks in Advance,

Kelli

[Mike Bartolatz]

did you check out Mandi Conway? her name appears on the list at Dr Foster's site but I know nothing about her.
with your Ankylosing spondylitis present and the HLA B27 gene going to Methotrexate after a steroid injection to tissue surrounding your eye might be the next step since you failed NSAID therapy. do you have a rheumatologist involved who would prescribe the MTX ?

your uveitis is chronic and it is time to move on in my lay opinion.

wish you the very best,
Mike