Ankylosing Spondalytis diagnosis and chronic iritis
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burnsmary99
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- Joined: Wed Apr 29, 2015 8:33 am
Ankylosing Spondalytis diagnosis and chronic iritis
Hi...I'm hoping you can help me. I live in North Central PA and 2 years ago I woke up with iritis in my right eye. I was treated with steroid drops and dialating drops. Over the course of the last 2 years, my iritis in my right eye only has flared 6 times and I have only been able to be off the steroid drops for no more than 6 weeks in between flare-ups. I was diagnoses with ankylosing spondalytis through the process of a work-up for the iritis and I have tested positive for the HLA-B27 antigen. I am followed by a local opthamologist and rheumatologist. I have also had care from a local retinologist and another opthamologist at a larger near-by health system. Besides the steroid drops, I now take 1000mg of naproxen daily. My rheumatologist wants to start me on Enbrel but I am nervous to go on such a "big" drug. I also know that I can't just continue on the steroid drops forever...any help or advice is greatly appreciated.
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Mike Bartolatz
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- Joined: Fri Feb 06, 2004 9:58 pm
Re: Ankylosing Spondalytis diagnosis and chronic iritis
Welcome to the group!
usually they have to start you on a DMARD drug such as methotrexate, Cellcept or Imuran before insurance will pay for a TNF A blocking drug to be added to the DMARD drug for best results. Enbrel is useless for iritis too. Remicade or Humira are better choices for a TNF A blocking drug. today much more is known about inflammation in ankylosing spondylitis. often it is caused by the IL23R gene which causes IL17 To be produced. this is called the TH17 pathway of inflammation. should Remicade or Humira not work, ask to be tested for this gene and then the drug Cosentyx which blocks IL17 could be prescribed.
if you have taken the NSAID for more than 6 months and it has not stopped recurrence of iritis, you might as well stop it and move to methotrexate right away.
Enbrel has been found to cause uveitis BTW.
there is a list of experts in the diagnosis and treatment of uveitis available through the Ocular Immunology and Uveitis foundation http://www.uveitis.org Patient information section of the site on the SPECIALIST list. I believe there is one at the University of PA.
the next closest one would be in NYC or Columbus Ohio. they will work with your local doctors in most instances. tell me where would be the best option for you to go and I will provide contact information for you.
your recurrent uveitis has to be stopped before the steroids cause glaucoma or cataracts to form. the uveitis itself can cause these things as well. each time you get a bout of iritis the chances of additional changes to the retina occur and you can develop fluid build up under the macula called cystoid macular Edema. this can lead to membrane forming over the CME called an epiretinal membrane. traction on the retina can cause it to detach or tear. these are some of the vision robbing consequences of uveitis. iritis is known as anterior uveitis.
wishing you the very best,
mike
usually they have to start you on a DMARD drug such as methotrexate, Cellcept or Imuran before insurance will pay for a TNF A blocking drug to be added to the DMARD drug for best results. Enbrel is useless for iritis too. Remicade or Humira are better choices for a TNF A blocking drug. today much more is known about inflammation in ankylosing spondylitis. often it is caused by the IL23R gene which causes IL17 To be produced. this is called the TH17 pathway of inflammation. should Remicade or Humira not work, ask to be tested for this gene and then the drug Cosentyx which blocks IL17 could be prescribed.
if you have taken the NSAID for more than 6 months and it has not stopped recurrence of iritis, you might as well stop it and move to methotrexate right away.
Enbrel has been found to cause uveitis BTW.
there is a list of experts in the diagnosis and treatment of uveitis available through the Ocular Immunology and Uveitis foundation http://www.uveitis.org Patient information section of the site on the SPECIALIST list. I believe there is one at the University of PA.
the next closest one would be in NYC or Columbus Ohio. they will work with your local doctors in most instances. tell me where would be the best option for you to go and I will provide contact information for you.
your recurrent uveitis has to be stopped before the steroids cause glaucoma or cataracts to form. the uveitis itself can cause these things as well. each time you get a bout of iritis the chances of additional changes to the retina occur and you can develop fluid build up under the macula called cystoid macular Edema. this can lead to membrane forming over the CME called an epiretinal membrane. traction on the retina can cause it to detach or tear. these are some of the vision robbing consequences of uveitis. iritis is known as anterior uveitis.
wishing you the very best,
mike
Mike Bartolatz
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burnsmary99
- Posts: 2
- Joined: Wed Apr 29, 2015 8:33 am
Re: Ankylosing Spondalytis diagnosis and chronic iritis
Thank you for the reply and the information. Obviously I'm extremely frustrated and confused at this point. I have been taking the Naproxen for a year now. Philadelphia would be the closest for me. If you have a contact person there I would appreciate the info. Thank you again for your help and the information.
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Mike Bartolatz
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- Joined: Fri Feb 06, 2004 9:58 pm
Re: Ankylosing Spondalytis diagnosis and chronic iritis
John H. Kempen, MD, PhD Background | Publications
Director, Ophthalmic Epidemiology
Center for Preventive Ophthalmology and Biostatistics
Director, Ocular Inflammation Service
Department of Ophthalmology/Scheie Eye Institute
School of Medicine
University of Pennsylvania
51 North 39th Street
Philadelphia, PA 19104
Appointments: 215-662 8100 | Office: 215-662 8155 | Fax: 215-243-4696 | Email
if one drug doesn't start working to get you off all steroids without inflammation within about 6 months, it is time to move on. there are MANY drugs to try. each of us is different in how we respond. having a specialist willing to take the time to get you there is key to preventing potential loss of vision to uveitis. getting the underlying disease such as ankylosing spondylitis controlled is also key. inflammation anywhere in your body can trigger renewed inflammation in the eyes from uveitis. infections can also trigger this.
hope this helps,
Mike
Director, Ophthalmic Epidemiology
Center for Preventive Ophthalmology and Biostatistics
Director, Ocular Inflammation Service
Department of Ophthalmology/Scheie Eye Institute
School of Medicine
University of Pennsylvania
51 North 39th Street
Philadelphia, PA 19104
Appointments: 215-662 8100 | Office: 215-662 8155 | Fax: 215-243-4696 | Email
if one drug doesn't start working to get you off all steroids without inflammation within about 6 months, it is time to move on. there are MANY drugs to try. each of us is different in how we respond. having a specialist willing to take the time to get you there is key to preventing potential loss of vision to uveitis. getting the underlying disease such as ankylosing spondylitis controlled is also key. inflammation anywhere in your body can trigger renewed inflammation in the eyes from uveitis. infections can also trigger this.
hope this helps,
Mike
Mike Bartolatz
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