Iritis.org

Outcomes of early and late immunomodulatory treatment in patients with HLA-B27-associated chronic uveitis.

Androudi S, Brazitikos P, Iaccheri B, Fiore T, Christen W, Meniconi M, Foster CS.

Ocular Immunology and Uveitis Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA 02114-3069, USA.

PURPOSE: To evaluate the outcomes of early versus late immunomodulatory treatment (IMT) in patients with HLA-B27-associated chronic uveitis. METHODS: Seventy-two patients (114 eyes) with HLA-B27-associated chronic uveitis received IMT at the Ocular Immunology & Uveitis Service of the Massachusetts Eye and Ear Infirmary and were evaluated retrospectively. Main outcome measures were visual acuity, control of inflammation, number of flare-ups and steroid-sparing effect. RESULTS: The median time between diagnosis and start of IMT was 3.05 years. Accordingly, patients were divided into two groups: group A comprised those in whom initiation of IMT was within the first 3 years (36 patients), and in group B initiation of IMT was more than 3 years from the initial diagnosis (36 patients). Control of inflammation was achieved in 29 patients (80.5%) of the early-treated group and in 33 patients (91.6%) of the late-treated group. A steroid-sparing effect was achieved for 13 (81.25%) of the 16 and for 11 (73.33%) of the 15 patients who were on systemic steroid in the early- and late-treated groups respectively. The mean follow-up for the early-treated group was 2.14 years and for the late-treated group, 3.46 years. CONCLUSIONS: Immunomodulatory therapy is an effective treatment for severe HLA-B27 uveitis that fails to respond to conventional steroid treatment, regardless of the timing of its initiation. However, introduction of IMT within 3 years of the disease onset prevents the adverse effects of steroids (cataract, glaucoma) and reduces the likelihood of repeated recurrences of the uveitis.

PMID: 14605907 [PubMed - indexed for MEDLINE]

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Posted: Thu May 26, 2005 10:05 pm Post subject: outcomes of treatment in HLA B27 uveitis

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1: Graefes Arch Clin Exp Ophthalmol. 2003 Dec;241(12):1000-5. Epub 2003 Nov 7. Related Articles, Links


Outcomes of early and late immunomodulatory treatment in patients with HLA-B27-associated chronic uveitis.

Androudi S, Brazitikos P, Iaccheri B, Fiore T, Christen W, Meniconi M, Foster CS.

Ocular Immunology and Uveitis Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA 02114-3069, USA.

PURPOSE: To evaluate the outcomes of early versus late immunomodulatory treatment (IMT) in patients with HLA-B27-associated chronic uveitis. METHODS: Seventy-two patients (114 eyes) with HLA-B27-associated chronic uveitis received IMT at the Ocular Immunology & Uveitis Service of the Massachusetts Eye and Ear Infirmary and were evaluated retrospectively. Main outcome measures were visual acuity, control of inflammation, number of flare-ups and steroid-sparing effect. RESULTS: The median time between diagnosis and start of IMT was 3.05 years. Accordingly, patients were divided into two groups: group A comprised those in whom initiation of IMT was within the first 3 years (36 patients), and in group B initiation of IMT was more than 3 years from the initial diagnosis (36 patients). Control of inflammation was achieved in 29 patients (80.5%) of the early-treated group and in 33 patients (91.6%) of the late-treated group. A steroid-sparing effect was achieved for 13 (81.25%) of the 16 and for 11 (73.33%) of the 15 patients who were on systemic steroid in the early- and late-treated groups respectively. The mean follow-up for the early-treated group was 2.14 years and for the late-treated group, 3.46 years. CONCLUSIONS: Immunomodulatory therapy is an effective treatment for severe HLA-B27 uveitis that fails to respond to conventional steroid treatment, regardless of the timing of its initiation. However, introduction of IMT within 3 years of the disease onset prevents the adverse effects of steroids (cataract, glaucoma) and reduces the likelihood of repeated recurrences of the uveitis.

PMID: 14605907 [PubMed - indexed for MEDLINE]
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What is IMT?

I'm new to this site, so I missed any explanation previously posted.

Lauren
North Carolina

Immunomodulatory therapy is a way of retraining the immune system using various medications. the first trial would be with Non Steroidal Anti inflammatory medications on a DAILY basis. Celebrex, vioxx, indomethacin and Voltaren are those most regularly used in adults. it these fail to stop inflammation then other drugs called immunomdulating drugs first used to treat transplant patients like Methotrexate etc are used to retrain the immune system to stop attacking your eyes or other parts of your body. You can read more about this in our Glossary.

I hope this helps and Welcome to the group. Please contact Dr Jaffe at Duke there in North Carolina so that such treatment can begin on you. Over time a steroid only approach to treatment can cause problems within the eyes and withing the body. for example, Cataracts and glaucoma can be caused by them from protracted use for recurrent or chronic uveitis. Steroid injections to tissue surrounding the eye can also add to these potential problems as can Oral/systemic corticosteroids. oral steroids can also lead to osteoporosis and type II diabetes. Steroid injections to joints in arthritis patients can lead to necrosis of the bone (bone death). Steroids can also weaken blood vessels within the body. hemorrhage can occur within the eye because of them.

wish you the best,
Mike

I have Anklosing Spondalitis and am HLAB27 pos. I get Iritis two to three times a year, with each bout lasting about 8 weeks.

Currently I have it in my left eye, and have been put on Prednisone Tablets. Also had the steroid injection 2 days ago.

Fixed the pain, but the vision is so hazy I couldn't even read the eye chart! Also the floaters are driving me crazy!
I am off work as I can't see properly. I can't drive. Its very frustrating.
Taking steroid drops every hour.
Just wondering how common Iritis is, and if other people get it as often as I do?

uveitis occurs in about 15% per 100,000 individuals from various causes. in some studies it has shown to be more frequent than that up to 60% of individuals in India from pathological causes. chlamydia T casuses trachoma as well as uveitis for example.

many individuals with the HLA B27 gene have recurrent bouts of uveitis. some are chronic and must use additional medications to quell the inflammation. the next 'step' on the step ladder approach to treatment of recurrent or chronic uveitis would be to try an NSAID such as Indomethacin SR, Naprosyn or Voltaren in hopes that the inflammatory process will be stopped and hopefully the corticosteroids can also be stopped.

I hope this helps,
mike

Mog wrote:I have Anklosing Spondalitis and am HLAB27 pos. I get Iritis two to three times a year, with each bout lasting about 8 weeks.

Currently I have it in my left eye, and have been put on Prednisone Tablets. Also had the steroid injection 2 days ago.

Fixed the pain, but the vision is so hazy I couldn't even read the eye chart! Also the floaters are driving me crazy!
I am off work as I can't see properly. I can't drive. Its very frist wondering how common Iritis is, and if other people get it as often as I do?

HI I HAVE IRITIS IT IS DRIVING ME CRAZY TO I FIRST GOT MY FLARE UP ABOUT 8 YEARS AGO THEN I GOT ANOTHER ABOUT A YEAR AGO NOW I HAVE IT AGAIN I JUST GO AN INJECTION AND DOING THE DROPS EVERY HOUR I HATE IT I TOOK OFF WORK FOR 3 DAYS I'M WONDERING DOES MOST PEOPLE TAKE OFF WORK WITH THIS I WAS A HAIRDRESSER FOR YEARS NOW I WORK AT THE HOSPITAL AND THE LIGHTS DRIVE ME CRAZY .

Hi,
I responded to your intro outlining strategies such as wearing polarized sunglasses inside and out. the wrap around ones work best as they prevent glare off of the back of the lens. they help with computer work too. lessening overhead lighting helps too.

I saw that you are from Boston. DR C Stephen Foster is the VERY BEST ocular immunologist in the World, he treats iritis and other forms of uveitis for a living unlike the rest of the opthalmologists who only see a limited number of cases in a lifetime.\
he is in Cambridge. you can contact him through his website at http://www.uveitis.org

starting NSAID therapy can stop this beast through use of Celebrex, dolobid, indomethacin SR etc or through the use of DMARD drugs (disease modifying anti rheumatic drugs). there are other clsasses of drugs too but these are the ones most often used.

please join in other posts when you feel like you want to share or ask questions. you can start a new thread too. we have other forums with lots of information available too.

please know that you are not alone!

Wish you the very best,
Mike Bartolatz

Treatment algorithms for Uveitis:
http://www.uveitis.org/medical/default.html

This is all very helpful. Thank you for the thread and for your response to my initial post.

~ Erika

Ask any questions you may have. we are here to help if we can. tell me where you live and I can suggest an Ocular Immunologist for a consultation.

wish you the very best,
mike

Mog wrote:I have Anklosing Spondalitis and am HLAB27 pos. I get Iritis two to three times a year, with each bout lasting about 8 weeks.

Currently I have it in my left eye, and have been put on Prednisone Tablets. Also had the steroid injection 2 days ago.

Fixed the pain, but the vision is so hazy I couldn't even read the eye chart! Also the floaters are driving me crazy!
I am off work as I can't see properly. I can't drive. Its very frustrating.
Taking steroid drops every hour.
Just wondering how common Iritis is, and if other people get it as often as I do?

Boy, do I feel for you. I'm in the same boat. I have AS, along with psoriatic arthritis and got my first flare of iritis about six or so years ago. The first episode was massive, and mis-diagnosed, which delayed proper treatment. That resulted in a very prolonged treatment period and permanent damage to the iris. Eight weeks for each bout seems long, if you were using any pred forte drops - but not sure how treatment works on prednisone tablets (that sounds weird). I've avoided the steroid ocular injection - freaks me out.

Unfortunately, my iritis is now chronic and none of the experts at UCLA, et al, can figure out how best to treat it. So ... given how bad my AS has been, I just started Remicade. I'm just on my second infusion, but it's very, very promising. I was in the middle of a major iritis flareup, and the eye was so hot and painful - and then felt normal right after the first infusion. As the drug wore off, my various issues flared up (expected), but once again after the second infusion ... ahhh.

Iritis isn't common, and highly aggressive iritis can cause real issues. As Mike has pointed out, continued steroid drop usage can lead to cataracts, etc., and you absolutely don't want to take prednisone pills long term. Have you looked into the immunomodulation/suppressive therapies? Starting with NSAIDs did nothing beyond alleviating pain from my arthritis - nothing for my iritis. Methotrexate made me very ill, but works well for others. If you're just being treated by a GP, get to a specialist. If you have a specialist, start talking about pulling out the 'big guns', like IMT or Remicade and its related drugs. I know how frustrating this is, but you do have choices - and if your docs aren't giving them to you, find better doctors. My rheumatologist is brilliant.