Iritis

Update

Well, my usual apologies for not posting anything in the last 60-70 days, but after I went on the Celebrex--aside from a little situation that I'm not sure was uveitis related (could have been BAK preservatives)--things have been pretty quiet.  Almost 11 months of no flares from taking Celebrex twice a day (200mg each time).  This is promising.

There were a few issues with Celebrex, however; namely, I was always worried about my stomach, I retained a lot of water on my body (slight edema) and my blood pressure seemed to go up.   This made me worry about the future, but generally I was pretty comfortable.

Around Thanksgiving, things got worse. I started to get severe heartburn and cramping and I started to worry that this might be caused by the Celebrex.  Looking back, Celebrex might have been a culprit or at least prevented healing, but generally, I had eaten a lot more starch than usual and was drinking a brand of coffee that I now know gave me an upset stomach.

Due to the stomach pain, I stopped the Celebrex about a week and a half ago and I've been struggling somewhat.  The good thing is that I lost a lot of water on my body--water that probably wasn't healthy for my heart.  Coming off the Celebrex has been, how do I put this? Ouch?  I've been using Voltaren Emulgel down my spine 3-4 times a day and massaging it in with heat.  Surprisingly I've found it as good as the Celebrex for the back pain, although I need someone to apply it each time.  Not the most efficient. If I go too long, my back immediately lets me know.

The problem is I can't put the cream in my eye.

After about 10 days, my right eye developed redness, aching, accomodation pain and a white nodule.  I can't say if it was nodular episcleritis or not, but the eye doctor told me that she saw no flare or cells.  This can often be because the inflammation is still in the iris and not in the vitreous, however, so who knows.

I did not treat (except for Nevanac, an NSAID drop) and the pain and aching has resolved quite a bit on its own.  That's the second time I have waited out an attack.  I'm hoping the anecdotal stories of inflammation gradually 'burning itself out' will be my case.  Right now, I'd say my back inflammation is almost as bad as my eye inflammation. Oh, by the way, I did do Dragonslayer's KickAS iritis protocol (not the fasting, the other thing) and that helped greatly.  After only a single try.

The other thing is that I started a probiotic (Align) and lactoferrin based on something I read about intestinal issues--and it seems my intestines have a ways to go.  A lot of pain in my gut.  If you believe that the microbiome influences the autoimmune system, then you might guess the connection I am making between inflammation in my body, my eyes and my gut.  I've never really suffered from IBS, but I wouldn't describe my intestines as 'no problem'.  Since a child I've had intestinal issues.  Is it working?  Too soon to tell, but there have been changes.

So that's it for now: off the Celebrex, on the Voltaren cream, probiotics, still taking tumeric and eating a no starch diet.  Managing okay, but I'm not working at the moment and trying to stay low stress.  Who knows what would happen if I started a 9-5, which I'll eventually have to go back to.  Pressures in the eye dropped to 16/16, which isn't bad.

I'm really anxious being off Celebrex, because it was like an insurance policy for me.  Will go back if there's more eye problems. I'll keep you updated.
Iritis

A post from the other side...

...of the Pacific, that is.

My apologies for neglecting this blog and the commenters for so long.  It has been over a month and during that month, several relocations and new starts have occurred--oh and one strange flare that you'll probably be interested in (since this blog isn't really about moving and new starts).

The good news is my eyes are calm and pressures are between 18 and 20 (right eye being slightly higher--not sure why).  When I arrived home after a long flight, I had slight photosensitivity and a lot of circumcorneal redness in my left eye which was enough to scare me into going to the doctor.  The local doctor that I saw told me that she couldn't see flare but that I had a lot of flush and that kind of flush around the cornea wasn't good--it either meant high pressure (pressure had dropped to 16 in the L eye) or inflammation (of which none was evident).

Anyhow, after some deliberation we decided to treat it more aggressively with Lotemax, saving the Pred Forte until later.  However, the more Lotemax I used, the worse the redness became.  I suspected that it might be dry eye (due to the stinging) so I also started a bottle of Systane (all I had available), but that didn't help.  Desperate I changed to pred forte, but again, there was no resolution.

After a few days, I returned to the eye doctor, the pressure was up (23) in the Left Eye and the doctor noticed corneal staining and pitting, which the she thought might be a response to the preservatives in the drops I was using (BAK and sodium perborate, I think).  She suggested using preservative-free Systane and this really improved the situation.  So much so that I broke a golden rule of treatment and stopped all steroid drops.  Could it be that this was a false alarm and the redness was from dry eye caused from the flight?  Steroids might exacerbate the dry eye, which was why I might have been getting worse the more steroids that I used.  If there was inflammation, I'm sure I'd find out about it when it rebounded.

Sure enough, my eye had cleared within days and I was off steroid drops altogether.  That was several weeks ago and my eyes have been fine since.  I have only stopped without tapering before when a ophthalmologist (Smith) forced me to (I couldn't get drops as easily in those days) and at that time, despite pressure pain, I was fine, too.

So lesson learned, even doctors can miss dry eye and photosensitivity can be caused by dryness, at least for me.  Next time I'll try dousing redness with wetting drops instead of jumping to treatment right away.  The disclaimer being of course that my flares are getting milder (yet longer) versus the fast and heavy flares I had in my youth.  I wouldn't recommend this for anyone else with uveitis.  Always see a specialist.

Hope that all makes sense.  Will update again soon (famous last words).  
Iritis

Dry Eyes, Uveitis and Rheumatoid Arthritis

Another quick update—my eyes are still stable and I’m approaching the one month mark after stopping all steroids (Pred Forte and Lotemax).  I still do a drop of Nevanac at bedtime, but I’m not sure how long I should continue this.  Not much information out there regarding long term use of NSAIDs as they are mostly used for cataract operations.  I would rather be using Bromfenac but at this point most of those products are unavailable due to Bausch and Lomb’s rebranding of the drug.

Not much has changed in my protocol—you can read that in detail a few posts back.  I’m still on a no starch diet, and I don’t know if that is having an effect at all, but I can tell you that it does affect my overall stiffness.  Still doing the Celebrex 200mg BID, but if I am clear for a few more months I might taper that to once a day and see how it goes.

Some recent posts on KickAS.org have been discussing dry eyes and their relation to autoimmune diseases such as rheumatoid arthritis, etc.  Add to this the damage done by steroids, BAK preservatives and inflammation and even though it is not a preventative of uveitis, care of the ocular surface is a pretty clear need for anyone with these conditions.

Here are a few of my thoughts on treating dry eyes and the remedies that accompany them:

Punctal Plugs

Haven’t tried them, but most people swear by them as the best outcome for dry eyes.  These are quite simply inserts in your tear ducts that block or slow the drainage of natural tears and keep the eyes wetter longer.  An alternative to surgery to seal the tear ducts, punctual plugs are non-invasive and as far as I know fully reversible. Can’t really comment much more as I haven’t tried them personally.

Restasis

This seems to be the mainline pharmaceutical treatment for dry eyes.   There’s a lot of information about this on the net—mostly that it is very irritating to the eyes to use the drops, but that it often yields good results. The important thing I learned is that this is a immunomodulatory drug that reconditions the lacrimal glands but also has some good anti-inflammatory effects on the eye (although not enough to be a uveitis treatment or preventative). I’ve tried this with mixed response.  Early on, I used a preservative free generic for almost a year with good results.  Recently, my eye gets too irritated after using it (and I’m still using the NSAID drop). There’s lots about this on Google.

Calf Blood Dialysate

Solcoseryl is an ocular salve that is used to heal corneal ulcers and regenerate eye tissue.  I have found it to be very effective—more so than normal eye gels.  It took a bit to get around the Calf blood bit, but studies have shown it to work well.   The reason I use it is not only for eye moisturizing, but also after damage caused by the preservatives in most pharmaceutical grade eye drops.  The most common preservative is still Benzalkonium Chloride (BAK)—the only drugs I’ve seen that don’t use this preservative are some of the new glaucoma/pressure drops because of the negative effect in that disease.  BAK kills the corneal surface, period.

Flax Seed

Omega 3 supplementation in the form of fish oil and flax seed has personally been helpful to me.  I feel that I have a thicker tear film after eating flaxmeal (I eat a few tablespoons like oatmeal in the morning with a little coconut cream and honey). Again, lots about this on Google.

Washes, compresses and eye pillows

These are all helpful.  I haven’t tried any specific eye washes, but have used a Neutrogena Salicylic acid face wash around the eye area with great effect against allergic itchy eyes.  Compresses both hot and cold work, but I find them messy and cooling/warming too quickly.  The best result I’ve had is to fill a sock with rice, flax seed or beans (don’t make it too heavy or it will blur your vision from pressure) and either cool it in the freezer or heat it in the microwave.  I’ve found the coolness helpful for the eye itself, but I’ve been reading that meibomian glands are stimulated by a warm compress so I’ve been trying that.

Again these are merely what I’ve investigated and not an exhaustive list.  For further reading, I suggest you start with a recent study posted at KickAS.org which gives a pretty good rundown.  There is a website called http://www.dryeyezone.com/
Iritis

Managing cataract and intraocular pressure while on inhaled steroids

Just a quick update: the eyes are clear and I’m off steroid drops.  I’m having problems with glare in my left eye now, however, which might be early symptoms of a cataract from the prolonged steroid use. My current ophthalmologist says not to worry, but my symptoms are very similar to this account here. I’m not sure there is much I can do at the moment except keep the eye quiet and find a good cataract surgeon in case this problem doesn't fade.  Whatever the case, I’m glad that I’m only on NSAIDs at the moment (Nevanac in the eye at bedtime and Celebrex 200 mg BID) and hope that when I feel less achy for a while (yes, I’ve had a few arthritic flares in the past weeks) I can scale down these drugs, too.

Something I've been meaning to mention on Eyeblog for a while now: if you've had uveitis before or had to use a systemic steroid long term, you probably know about the risks prolonged steroid usage has on the eyes--subcapsular cataract, raised intraocular pressure and glaucoma, to name a few.   But while taking steroids internally puts one at greatest risk, other steroid preparations have hidden risks, too.

Two years ago, in the summer, I was getting a routine checkup (my eyes had been clear for quite a while) and it was revealed to me that I had raised intraocular pressure.  This was startling since I had not used any steroid eye drops for a while and had not taken any steroids internally.  In the end it turned out that the raised pressure was steroid related, however:  I had overlooked a nasal spray that I was using for my allergies.

As it turns out, even though nasal sprays aren't supposed to be absorbed anywhere else in the body, and there are numerous safety studies on normal, healthy people, there is evidence that they can have an effect on intraocular pressure and carry some of the same risks as the steroid drops and internal steroids.

The medical literature is spotty on the facts and there are several safety studies saying it’s not a risk, but for people who respond to steroids or have a pre-existing condition, I feel the warning should be clearer: if you use inhaled steroids for asthma or allergies, monitor your intraocular pressure (IOP) and realize there is an increased risk for cataracts in your future.

After I figured out that the nasal spray was causing the potentially-blinding pressure spike in my eyes, it took about two months for the pressure to return to normal, longer than it ever has when it spiked on Pred Forte drops.  At the time, my doctor and I surmised that this might have been due to residual nasal spray in the sinus cavity.

For your interest, I list the following studies below which have found a positive relationship between inhaled nasal steroids and intraocular pressure or cataract.  For IOP the evidence is not conclusve, but having personally experienced this, I thought I’d select some of the positive studies in case it helps anyone who has uveitis and uses a nasal spray. That’s all for now—next post I hope to reveal some of the literature I’ve reviewed on breakthroughs on using Statins to treat uveitis inflammation (and MS).

Discontinuing nasal steroids might lower intraocular pressure in glaucoma.

"A significant reduction in IOP occurred with nasal steroid discontinuation in patients with glaucoma. Nasal steroids might contribute to IOP increase, and inquiry as to whether a patient has glaucoma before medication initiation is warranted."

Effects of three nasal topical steroids in the intraocular pressure compartment.

"Fluticasone propionate, mometasone furoate, and beclomethasone dipropionate cause variations in the intraocular pressure, but the variations are within normal limits."

Use of inhaled and oral corticosteroids and the long-term risk of cataract.

"High long-term risks of PSC and nuclear cataract development were found for users of combined inhaled and oral corticosteroids."

The effect of nasal steroid administration on intraocular pressure.

"It is likely that the side effects of the absorbed steroids depend not only on the type of steroid given, but also on the duration of administration. Therefore, further research is needed to determine the possible relationship between steroids and IOP when administered over a long period. Until that relationship has been established, we recommend that IOP and the condition of the optic nerve be observed during long-term administration of nasal steroids."
Iritis

Off the drops, but is it too late?

Just another quick update:  I’m off the drops now.  Just surviving on Celebrex 200mg BID.  Feeling a bit anxious, because it feels like Celebrex doesn’t totally ‘cover’ the inflammation--I had a bit of a flare with really bad knees, hips and shoulders for a couple of days. This was accompanied by what seemed like a bit of food poisoning, and I also went off the No Starch Diet a week before and had a few beers on the weekend.  Don’t know if any of that played a role or not.

What’s worrying though is that my left eye seems foggy.  I guess that I couldn't have avoided a cataract forever, and maybe since switching to the Lotemax it has precipitated this, but it just seems strange that I should suddenly just notice that everything is hazy and white, especially in bright light.

A trip to the Ophthalmologist revealed that my eye was fine and he didn't seem too concerned with cataracts since my vision was 1.2 (about 20/20) on a vision test.  I’m not sure what he saw on the lens, but I hope he’s right.  I’m just hoping the haze will fade after a while.

So anyway, I’m back on the No Starch Diet for now, taking turmeric when I remember and Celebrex twice a day. Still feeling tired most days, but I’m trying to get in daily walks.  The real test will be if I’m still clear by mid-April.  I hope I can stay off the drops.

Something else of note is that I’m starting to have problems with clogging and ringing in my ears and accompanying pain in the sinuses. Don’t know if that is related (as in withdrawal from the steroid drops, complications from the NSAIDs, sinus infection or worse (VKH)) but I’m going to wait for a bit to see if things calm down before I go exploring.  Already been to a GP who found nothing, so the next step is an ENT if this doesn't clear up.

Thanks for reading as always—lots more research and notes to update you with soon!
Iritis

New question to ask in uveitis diagnosis: do you have any tattoos?

I've been following an interesting set of cases on the relationship between tattoos and uveitis.  At first there was only one or two case studies, but recently a presentation at a John Hopkins University conference was more specific than before:

"Physicians who treat uveitis should ask patients about any tattoo changes. Some component of black tattoo ink may act as an environmental trigger—leading to the development of simultaneous bilateral ocular inflammation and elevation of tattooed skin."

"Though tattoo-associated uveitis is rarely reported, the likelihood of its presence is more common than the literature would suggest, according to Trucian Ostheimer, MD....Interestingly, he has seen seven such patients since beginning his fellowship with the Wilmer Ocular Immunology Service."

"Five of seven patients had bilateral non-granulomatous anterior uveitis—four with chronic and one with recurrent disease. Two patients had bilateral chronic granulomatous panuveitis. Initial visual acuity varied widely."

"Most of the patients had extensive tattoos, and many of these were multicolored. Interestingly, only portions of tattooed skin containing black pigment were affected and visibly raised."

“'Histologically, this can be classified as a foreign body or sarcoid-type reaction, and the differentiation of these two types of granulomas may be challenging and open to controversy,' Dr. Ostheimer said. 'The skin biopsies performed in two of our patients and in some prior reports displayed non-caseating inflammation in association with dermal tattoo pigment that I believe is consistent with, but not specific for, sarcoidosis.'"

“'It’s useful as part of your uveitic review of systems to ask patients who have uveitis about tattoo changes,' Dr. Ostheimer continued. 'It is purely speculative, but I think it is reasonable to conclude that there may be some component of black tattoo ink that acts as an environmental trigger—leading to the development of simultaneous bilateral ocular inflammation and elevation of tattooed skin.'”

Iritis

Hopeful news on cures and remissions

Two recent pieces of literature caught my eye where some interesting breakthroughs have been made, confirming in some ways, what many people have thought to be true.

The first is a review of a study I mentioned sometime back, on Chlamydia-induced arthritis that was cured (yes, that's the word used in the article) by a combination antibiotic approach.

The article was featured in MedPageToday and features, Toronto professor of immunology and medicine Robert Inman saying of rheumatology, "We've always had this notion that some of our diseases may be infectious in origin."

This finding is relevant because, although Chlamydia is usually seen as a sexually transmitted disease, "pulmonary infection with a related pathogen, C. pneumoniae, is a common cause of upper respiratory tract illness. Both microbes have been implicated in the chronic spondylarthropathy following infection acquired across a mucosal surface."

Further, "multiple strains, or serovars, associated with genital and ocular infections have been identified, with the A, B, Ba, and C serovars being ocular" and in a study of 36 tested individuals with reactive arthritis they found that every single sample was of the ocular variety, not genital.

"The observation that it's the ocular strains that are arithrogenic also helps explain the common finding of conjunctivitis and iritis in patients with the reactive arthritis"  That is, the old, "can't see, can't pee, can't climb a tree" diagnosis from the WWI and WWII days.

Here's where it gets interesting--and why I'm not taking biologics at the moment.

"There are two schools of thought on treatment of Chlamydia-induced arthritis...[o]ne says that the pathogen triggers an autoimmune response that you should treat like any chronic autoimmune condition," that is with immunomodulating drugs such as DMARDS, including the newer biologics such as the -umabs.

However, "the other says that because the trigger is bacterial, and if you can demonstrate evidence of the viable -- if aberrant -- bacteria in the synovium, antibiotics could be used."

While TNF inhibitors have been used with great success to stop the body's immune response and limit damage, there is some indication that this merely treats the symptom as "a patient with Chlamydia-induced arthritis who was given etanercept (Enbrel) appeared to respond clinically, but on a post-treatment synovial biopsy the microbial load had increased ten-fold."
What makes this treatment approach revolutionary is the dual antibiotic approach, much like that given to patients who contract pneumonia.  Single antibiotic approaches against arthritis have been unsuccessful.  The addition of a powerful antibiotic such as rifampin targets the bacteria in the tissue, combined with a -mycin or -cycline to block the bacteria's protein synthesis.

While this has been successful in treatment of chlamydia-induced arthritis, other pathogen induced arthritis (e.g. salmonella) hasn't shown the same response. Yet, this to me, this promise of a cure shows more need for testing and diagnosis rather than a one-size-fits-all approach of prescribing immunosuppressors for every patient with rheumatoid complaints.


Speaking of Salmonella, another post at KickAS.org brought to my attention of some research connecting the HLA-B27 gene, the hallmark gene of ankylosing spondylitis and gut-induced bacterial inflammation such as irritable bowel disease (IBD).  The idea here is that HLA-B27 individuals may be more susceptible to infections by certain enteric bacteria and therefore be more prone to developing spondyloarthropathy-type (SpA) diseases.  In this test, mice with the HLA-B27 showed a difference in reaction to bacterial challenges, prompting the researchers to draw the conclusion that " the HLA-B27 status directly influences the composition of the gut microbiome. This raises the possibility that the clinical interface between SpA and IBD could be mediated by an interplay between host MHC and the gut microflora."

All this is rather exciting for me, because it shows a change in direction for the medical community and an opening acceptance that these diseases still might be cured, rather than managed.  For someone like me with diagnoses of ocular rosacea, uveitis and ankylosing spondylitis with definite links to episodes of enteric infections (i.e. food poisoning), this predisposes me to try to avoid biologics that decrease the immune system as long as possible in hope that further discoveries might be made involving antibiotic-based treatment to achieve a remission or 'cured' status.  The next frontier for treating inflammation and disease may very well take place in the gut.


Oh and by the way, I went to the ophthalmologist recently.  I'm still stable.  My eyes are looking better superficially, but also my pressures are stable at about 20/19 (L/R) and there is no sign of inflammation.  I've added some starchy meals recently and there has been little effect other than a bit more morning stiffness, which says to me to continue to stay no starch.  Generally feeling healthy and disease free aside from a little stiffness and aches at the moment.  Not going to say remission, yet.  But definitely doing a lot better.   Next step is going to be to either stop the daily Lotemax in the left eye or decrease the 200mg twice-daily Celebrex.  But I think I might enjoy another few weeks of clear eyes and no pain first.  Fingers crossed.
Iritis

Another quick update

Just a little quick update regarding my eyes: no news is good news and judging from how long I've let time go between blogs, I've had some success at getting my eyes closer remission. I've been preparing for an international relocation again, too,  so please bear with the spotty posting these days!

As previously mentioned, a combination of natural and pharmaceutical tactics have gotten me to a good place right now.  Medically, I'm still doing a drop of Lotemax in the left eye daily, and taking Celebrex 200mg twice a day. Alternatively,  I'm also still following a no starch diet and taking turmeric (when I remember it) as well as restricting any foods I feel make me feel uncomfortable.  I also use a few tricks I picked up from Dragonslayer's Iritis Protocol over at KickAS.org--hate to mention it, but the salt and soda seemed to help a lot.

This got me thinking that the salt water may be hydrating me so I started to look more seriously at dry eye treatments.   I started to try Solcoseryl which is an ocular gel fortified with hemodialysate of calves blood (yeah, it took me a little while to get around that, too).  Again, my layman's understanding is lacking, but this compound accelerates wound healing by interacting with red blood cells--it's basically a tonic taken from the blood of health calves and used as a wound salve.

Along with some OTC wetting drops (GenTeal and Systane Ultra) Solcoseryl really helped get my eyes from pink/red to white again.   They are staying white longer, too.  Again, the way I understand it is that the steroid drop causes rapid growth and development of cells but the young cells are weak and prone to inflammation, so this is like a tonic for these new cells in the eye.  Both Pred Forte and Lotemax use Benzalkonium Chloride as a preservative, which is not good for corneal cells, so I need all the help I can get.  It is interesting to note that Solcoseryl has also had a big impact on my sinuses, too (probably from draining into them through the nasolacrimal duct).

This lead me to wonder a little bit as to the source of the whole iritis problem, as there are many competing theories: Ebringer, et al. argue that Klebsiella in the gut cause a reaction that leads to inflammation throughout the body, yet for some who have iritis and only secondary AS (like me), this doesn't explain everything.  More traditional explanations have to do with infection and that leads me to believe that my sinuses might play a role (especially as a long time allergy sufferer).  Many people complain that iritis flares around allergy season and my flares (at least in Canada) would be no exception.  Anyhow, I'm digressing...

So, in my seeming habit of pairing the medical (Solcoseryl) with the natural, I also found a lot of writing on Astaxanthin and started that as well.  Seeing that there has been good reports of this 'super' carotenoid's anti-cataract  and free-radical scavenging abilities, I figure it can't hurt to add it in with the turmeric each day.  You are supposed to take it with a high fat meal, which isn't too much of a problem when I'm on a no-starch diet.

One final note, it's become almost impossible to get Bromfenac.  It seems Bausch & Lomb have released a newly formulated Bromfenac solution and mysteriously all the generic drug companies have stopped making it.  Were I a conspiracy theorist, I might say something about that.  But I just want to get the drug which is now selling at about 10 times the price for 30% less strength.  Because of this it has about 1% of the availability.  Uveitis has become quite the hot market, hasn't it?  For now, I'm stuck with Nevanac which doesn't quite have the penetration I'd like to have into the eye.

Whatever the case, I'm feeling more confident in the eye and I've been about three weeks to a month without any big complications.  I'm certainly hoping that I can stop the drops soon.
Iritis

Natural sea urchin pigment shows promise as possible iritis treatment

Sea Urchins are a rare delicacy in places like Japan (the challenging 'Uni' in sushi dishes for example).  Recent research from the country, however, suggests that a certain kind of sea urchin pigment, known as echinochrome, has been used to successfully treat chemically-induced uveitis inflammation (EIU) in rats.  The substance echinochrome is found in the shells and spines of sea urchin and has traditionally been used in cattle feed but has been gaining popularity as a health supplement in places like Russia..

Recent research published in Molecular Vision shows a promising study for a naturally-derived intraocular treatment

"Echinochrome ameliorated intraocular inflammation caused by EIU by reducing ROS production, thereby also decreasing the expression of NFκB and TNF-α. As a natural pigment, echinochrome may therefore be a promising candidate for the safe treatment of intraocular inflammation. The use of sea urchin shells and spines in health foods and medical products is thus both economically and environmentally meaningful."

The reason that this is interesting to me is the following:

"Several other substances, including resveratrol and astaxanthin, have been reported to have ameliorative effects on EIU....However, most of these antioxidant substances are poorly soluble in water, and therefore can only be applied orally or subcutaneously; this reduces the amount of substances that effectively reaches the ocular tissue and delays the onset of the drug’s effect. Echinochrome is water soluble and can be administered intravenously, thereby reaching the eyes within seconds after administration. Echinochrome has already been approved as an experimental treatment for acute infarction in humans, and it has been used as a human dietary supplement in Russia with no reported serious side effects."

All of the above substances work on something called the ROS pathway which has to do with reactive oxygen species causing an immune response through the production of Nuclear Factor kB (NFkB) and TNF-α. TNF is targeted by current medical treatments for reduction (anti-TNF-α such as Humira, Enbrel, etc.) when autoimmune inflammatory diseases are suspected. When NFkB, responsible for the body's response to infection, is regulated incorrectly you get a host of autoimmune problems, not to mention cancer, etc.  Similar to TNF-α which is implicated in Alzheimer's, IBS, cancer, and depression.  Anyhow, to my layman's mind, malfunctioning of this system is responsible for uveitis as proteins and cells leak into the eye causing the uvea to become inflamed.

The possibility of a 'shot' of a naturally occurring pigment that would treat uveitis from the inside or even prevent uveitis from occurring is quite a scintillating idea.  I'm putting this one on my follow list... until then, falling prices on the failed miracle supplements resveratrol and astaxanthin are all we have ;)
Iritis

4 steps to a possible remission from iritis

Well, after a rather dreary previous post (sorry, needed to wrap my head around all that was going on) I have a few rays of light to share with you, I have a few rays of light to share with you regarding getting back into a possible remission from iritis/anterior uveitis:

Lotemax and IOP

Ophthalmologist reports no inflammation and the pressures are 21/18 (down from 24 in the left and steady at 18 in the right).  This means the Lotemax plan is working for me!  Yes!  My pressures have reduced in two weeks since switching from Pred Forte to Lotemax. This seems like a good plan:  (1) treat with the Pred Forte and oral NSAIDs to extinguish the iritis (usually only takes a few days), (2) then begin a long taper, (3) when intraocular pressures spike at the 3-4 week point, switch to Lotemax and continue to taper.

At this point, I'm going to continue doing Lotemax for another few weeks in both eyes in order to keep myself stable.  I'll check pressures again in a month and let you know if I've normalized.

An NSAID drop for mild iritis

I've been able to acquire some Bromfenac drops, which is one of the only topical NSAID drops I've heard Dr. Foster mention that can treat mild iritis (more on that in a future post). My next step, after completing another few weeks on the Lotemax is to go to the Bromfenac and see if that gets under control.  If there are no more flares after a month of Bromfenac, I plan to lower the Celebrex to 200mg a day.  At least then I'll be at the lowest risk for complications long term.  Since my iritis is generally pretty mild, this seems like a very plausible holding pattern.

A starchy discovery

Right before my most recent flare, I had quite a lot of almond nougat which I tested to make sure was starch free with iodine--at least I tested the nougat.  Today, I found the same nougat in the stores and noticed that they weren't full of almonds at all, actually they were peanut.  Something that is full of starch and I have a sensitivity to (at least they told me not to eat it after a barium swallow when I was young). This is a very suspicious coincidence between my diet and my flare.  Last time I had a flare, I went out for beer and ate a bunch of stuff that I don't remember (because it was after the beer!).  I had also had a pizza about 3 days before the nougat on an unrelated moment of weakness, so the peanuts might have been the proverbial straw that inflamed the camel's SI joint. Anecdotally speaking, if you believe the enteric trigger of AS by a starchy diet theory, there really might be something to this--more on that in a moment.

My plan

At this point, I plan to continue Celebrex 200mg bid, Lotemax OS/OD qd and a low starch diet for the next month.  If I have no flares, I will switch to Bromfenac OS/OD bid during the last week of that month.  Based on the success of John/Dragonslayer's Iritis protocol (still too embarrassed to mention that it helped, ha) i'm going to see about taking 10 days of Rifaximin 400mg tid and see if there are any results with that.  (Still need to check about Celebrex interactions, but I think I'm okay.)

While this might sound like I've gone off the deep end, here is my reasoning: since I have had IBS and ocular rosacea symptoms (diagnosed by a uveitis specialist) Rifaximin seems very promising. I have to admit, I don't see too much rosacea on my body, but the ocular diagnosis plus the improvement on the no starch diet and John's AS protocol are compelling enough to take a gamble on this--especially since the side effects are much less than Anti-TNFs.  Ciprofloxacin is much more dangerous and can even result in uveitis, so I am hesitant to try that.

Anyhow, I have something much better than I had yesterday.  Hope.