Iritis and pregnancy

[Mbreshears]

I am sorry if I am beating a dead horse with this post, but I haven't found what I am looking for. . . I am in my second flarw of iritis, the first was just over 3 1/2 years ago. Weird thing is, my first flare showed up in my last trimester of pregnancy. And EVERYTHING I have read says it shouldn't show up then. . .It was stubborn, and didn't go away for about a month after delivery, total of about two months maybe a bit more. My daughter was born ten days early. It would get better, I might even taper off drops, and it would flare again during this time. I received one injection in the first couple weeks because it wasn't responding. Fast forward three and a half years, and I flared up, though not neaerly as bad, and I just found out I am pregnant again. . . It is slightly possible it flared right before I conceived, though it is definitely worse after. Again, it is stubborn, and I will even taper off drops (once) and it flared back up, I e been doing Pred Forte drops every two hours for the week, with gel at night, and it just doesn't care. The pain comes and goes throughout the day. I am concerned that this will be chronic throughout the pregnancy since I first flared in third trimester. Anyone have any knowledge or experience to share? I will add that I am HLA-B27 positive, and my dad has had flares often throughout his life. He may have some arthritis-esque issues connected to it, but no textbook diagnosis. He is now dealing with cataracts
that areI inoperable from the awful drops. Is it possible for the iritis to be connected just to pregnancy? It didn't show up until the end of my 3rd pregnancy, this is my 4th. Also, is it possible for a related condition to involve primarily inflammation of tendon tie ins? For example, plantar fasciitis, IT band, other tie ins around knee or hips? Thanks for your help!!

[Mike Bartolatz]

yes, the plantar f. and achilles tendon stuff are halmark signs of reactive arthritis linked to the HLA B27 gene. enthesis is the term for inflammation associated with the connection between tendons and ligaments to bone.
are you on dilating drops along with the steroid drops to help with the pain from adhesion between the iris and lens causing the cilary body to spasm?

once you have the baby and you are finished with breast feeding, try using an NSAID taken daily at prescription strength to stop the recurrent nature of you HLA B27 uveitis. this works in about 70% of patients. the steroids will lead to cataracts and glaucoma over time as is the case with your dad. Cataracts surgery can be done for your dad. the eye has to be quiet for 3 months before the surgery. they pretreat with steroids and then use Durezol eyedrops to keep the uveitis from flaring up.

I had both of my eyes done 15 years ago.

wish you the best,
Mike

[Mbreshears]

It is possible my frequent use of NSAIDs is what has kept things from flaring up since the first flare. . . Because ofI headache, muscle tension and tightness issues. Do you know why I would have flared in 3rd trimester when I should be least likely to flare?

[Mbreshears]

Apparently there is something else on/in the eye that makes my Dad high risk for the surgery. I don't know exactly what, but I guess they figure limited vision is better than no vision at this poimt. Drives me nuts. . . Trying to figure out if we need to take him to get a second opinion.

[Mike Bartolatz]

no I don't know why you flared in the third trimester as you know, usually the hormonal levels in a pregnant woman keeps the eye quiet during this time.

usually it is active uveitis that keeps one from having IOL surgery. does he have glaucoma?

wish you both the very best,
Mike

[Mbreshears]

Thank you so much for your input! No, he doesn't have glaucoma. I need to ask him what the deal is... It has been about a month and a half since my first post, and I am on durezol instead of pred forte. I had almost a week off the drops... Woo Hoo! Looking to see if my insurance will cover a pair of eyeglasses, since I have spent most of the fall in only one contact, which doesn't work with snowy roads and limited daylight. Just wanted to say thanks and give an update. I am now 13 1/2 weeks pregnant, so I am out of 1st trimester and still flared... Doing a longer taper period so will see in three weeks if I can finally get off these awful drops.

[Mike Bartolatz]

make sure you get your pressure inside your eyes checked FREQUENTLY while on durezol. the prescribing literature suggests that it only be used for two weeks because of it's propensity to raise pressure inside the eyes causing glaucoma. there can be no symptom of glaucoma by the way. the first thing people occasionally notice is rainbows around lights. vomitting is caused when pressure gets really high. pain rarely occurs with glaucoma. suggest you ask to be checked every couple of weeks at a minimum while on this especially since your dad has glaucoma.

glad you are doing well at the 3 month point of your pregnancy too.

Have a merry Christmas!
mike