Iritis lasting for more than 3 months

[ap123]

Hi Mike,

I have spent a lot of time reading posts here. great job - thanks for doing this.

I was first diagnosed with anterior uveitis in Mid August (left eye only). Initially they put me on 4 drops of predesolon a day. In a week's time, it did not improve much - so they increased it to every two hours. Following week, there was significant improvement, and they started tapering off. They took my off the drug after in September middle and asked me to revisit in October. It was back - just a trace though. They put me back on 4 times a day of predesolom. This time they ordered a host of tests - including the tests for AS, Lupus, Sarcoidosis, TB, Syphhlis, Herpes Zortox, Chest X-ray, - they all came back normal. After a week my inflamation was gone and they started tapering it off. 3 times a day for two weeks followed by twice a day for two weeks. When I went for the follow up (three days ago) my eye pressure was abnormally high. My doctor said it was due to steroid's side effect. He also said that my iritis is "essentially gone". So he put me on a drop a day for two days alongwith some drop to control eye pressure. I met him yesterday - pressure is back to normal. But flare up is back again (1+ to 2). I am getting frustrated. With no obvious systemic desease (at least based on the tests so far), my optho has now referred me to an uveitis expert in the same eye hospital. I will meet her next week. He checked the back of my eye etc. and says I do not have any issues with intermediate or back part.

But I am worried now and have a few questions:

1. Can iritis last like this for more than 3 months without any systemic casue?
2. Could it be that my tapering off strategy is not well managed. So I leave it and it comes back.
3. Given my IPO the doctor has now changed my drug to a low potency flurometholone 4 times a day along with pressure control drug. I am guessing this will be too weak to control my iritis, but I guess I just have to wait for my meeting next week.
4. Is there any other question I need to ask?

Another thing: Though they tested me negative for HLA B27, I have complained about back pain and pain n general rib cage area with my GP for about three years now, my sister also has Spondylytis. Are they missing AS here - focussing too much on HLA B27?

I know I am asking a lot of questions - just getting frustrated and worried given the duration.

Thanks a lot,
AP

[Mike Bartolatz]

Sorry you are having a difficult time with the uveitis and steroid eyedrops and now have to take the pressure lowering drugs to prevent damage inside your eyes.
although HLA B27 is most commonly related to both Uveitis and ankylosing spondylitis, crohn's, psoriatic arthritis, reactive arthritis and ulcerative colitis, about 2007 addintional genes were discovered IL23R, ERAP1, IL1R2 linking many of these things and various causes of autoimmune uveitis.
IL1B has also been linked to JRA, arthriits of the hands and Sarcoidosis and even type II diabetes.

so my point is there are many things associated with arthritis and uveitis besides HLA B27. about 30% of ankylosing spondlylitis don't have the HLA B27 gene,
about 30% of autoimmune uveitis cases are never found to be linked to a cause but this may change now that various genes have been discovered linking them.
the main thing is to get the chronic uveitis controlled as quickly as is possible now that a pathogen has been ruled out. adding an NSAID such as celebrex, dolobid or naprosyn MIGHT help calm your eyes down and keep the uveitis quiet. the goal is off all steroids without inflammation, then one stays on the NSAID for an additional two years allowing the immune system to learn not to replicate the errant cells attacking your eyes.

you might consider a consultation with an Ocular immunologist. a list of these rare specialists can be found at http://www.uveitis.org in the PATIENT information section of the site. both US and international lists are available.

Please join us in various forums at this site. click on BOARD INDEX to be be redirected to our list of forum. then join in the discussion or start a new topic.

wishing you the very best,
Mike