A bit frustrated

[tiffanymccalla]

I am currently being treated for bilateral iritis. My first episode started July 2013 and lasted 3 months. It resolved with Pred Forte drops only. I subsequently tested hla b27 positive with a MRI negative for AS (just showed arthritic changes).

This current episode started in January 2014 and did not improve with Pred Forte. I was subsequently started on Durezol but I can't get below 3 drops daily. My initial oral Prednisone treatment led to a relatively quiet eye but I then failed the Durezol taper. Today I am on the last day of my second 2 week course of Prednisone 60mg daily and I still have slight light sensitivity which is typically associated with 1+ cells for me.

I am seen at Bascom Palmer Eye by a fellow and Dr. Janet Davis. They are both great but I am not sure what else to do. It seems that this flare is not going away!

I guess my question is how long do I continue on the same path before doing something different? I am not well enough controlled to stop steroids but certainly I did not plan to be on them forever. I am still breastfeeding and hoped to have another child before 40 (I am 38 next week). At what point do you entertain additional/ alternative treatments or is that for more severe disease? Any additional recommendations?

Sorry so long winded but thanks for reading.
Tiffany

[Mike Bartolatz]

tough question to answer. you and Dr Davis will have to decide what to do going forward. while you are pregnant, the only drugs you can take are steroids or Durezol. once you have the baby your eyes will most likely flare up and then you can discuss alternative to steroids such as NSAID therapy since you have the HLA B27 gene and arthritis. other option while not pregnant would be DMARD drugs such as methotrexate, Cellcept or Imuran. you cannot get pregnant while on these drugs.

recurrent uveitis can eventually damage your eyes through either the steroids or the disease. getting the underlying disease calmed down is key to all of this. as long as you have inflammation anywhere in your body, the iritis can return again and again. a disease modifying steroid sparing approach is required to stop the recurrent or chronic nature of this. cataracts and glaucoma frequently occur from both the inflammation and from steroid use. the oral steroids can also lead to type II diabetes so make sure you get tested for this especially since you are pregnant. bone density loss can also occur as can damage to joints from bone death. not meant to scare you but your doctors have to discuss this with you.

wishing you the very best,
Mike