Kickas.org Forums Ankylosing Spondylitis General Discussion #1 AS Web Support Group ESR and iritis

Does anybody know, or have a comment, regarding the ESR test and the involvement of iritis.

Should the ESR test track with the degree of inflammation in my affected eye? I have had the same case of ongoing iritis for over 1 year now...and I'm getting a little tired of it. I'm thinking of having another ESR test done.......

Cheers,
Rita

James, 12, Adrian, 10, Elisabeth, 3, my babies!

I had iritis 3 times this year, and only once was my ESR significantly elevated.

Hey Merlin. What was your ESR up to when it was significantly elevated during an iritis flare? My last test on Jan 18/07 was 32. But on Aug 3rd, 06 it was only 18, and I was definately in an iritis flare then. And another test done on Aug 31.06 shows a 32.???????? why doesn't it track? iritis is inflammtion and ESR is supposed to measure inflammation....

Hmmmm...also I was NSD starting Sep 20/06 and my 32 on Aug 31/06 matches the 32 on Jan 18/07 {after months of NSD}. Does that mean the NSD isn't helping my iritis????

Anyone else with any more comments?

Cheers,
Rita

James, 12, Adrian, 10, Elisabeth, 3, my babies!

Hi Rita,

I can't recall if you have said... do you have chronic iritis and are you on a maintenance schedule of steroid drops?

My ESR use to range anywhere between 50 to mid-80's. I fought iritis for about a decade, at first with single acute attacks which later morphed into chronic iritis (mixed with the occasional acute attack). It never seemed to track with my sed rate either but then mine was consistently high. Since Remicade my ESR has basically dropped to being within the normal range and with that the iritis disappeared.

ESR measures overall inflammation and since the eye is so tiny, I doubt it could affect your sed rate, even in an acute flare. It's also only a rough gauge and is known to be unreliable in some AS patients. 32 is elevated and it doesn't take much... I tend to think of it as the canary in the coal mine.

If you haven't had an acute attack since being on NSD then who knows... it isn't hurting matters by the sounds of it.

Hope this helps a little,
mig

Hi, Rita:

If your ESR normally tracks disease activity, and you have iritis it should be assumed that you are in a flare, or very active status. Some people, however, will never have increased ESR no matter how bad their flare (approximately just over 40% of those with AS).

For the rest of us whose ESR will accurately track with disease activity, iritis could happen above a certain ESR, and it would be another factor affecting the actual measurement of ESR to affect the result--drugs taken for iritis (almost immediately, of course), length of time blood specimen sat before the test started, the type of collection tube used, diet immediately before the blood draw, and many other factors.

Yes, it might be wise to have it redrawn and mention to the lab that you did not believe the previous result.

Best to You,
John

Hi Rita,

My ESR has been elevated the last three test. My Rheumy is sending me for another MRI of my SI joints. He said he seen something there on my x-ray and believe it to be inflamation action there. I over heard the technician say that I have the beginnings of AS. I have already been diagnosed, but hay I will let the new rheumy do his testing. I am HLA B27 positive. As to the correlation between ESR and Irtis, I am sorry I can't help you there.

I tend to get sjogrens a lot and it does affect my eyes.

My eye doctor doesn't believe it's Iritis.

Hugs

Gerri

Hi Mig, thanks for answering my question!

I started an 'iritis flare' last July. Since then it has had its ups and downs when I need to put more steroid drops in daily. Usually, and right now, I have been using one dilating drop and one steroid drop in the am, and another steroid drop before bed. The cataract seems to have stopped progressing for the moment. The eye sight is clouded, with floaters, and cobwebs, no matter how many drops I use. The close-up vision is toast also, and I am starting to get nervous driving in unfamiliar territory. [it is my left eye] I haven't been able to drive at night or in the rain for ages! And I haven't been able to do some of my favourite crafts 'cause of the loss of close-up vision.

The highest my ESR has been is 32. But, I have only had it tested 3 times in the last year. I will ask for another test to see what it is up to now.

****ESR measures overall inflammation and since the eye is so tiny, I doubt it could affect your sed rate, even in an acute flare. It's also only a rough gauge and is known to be unreliable in some AS patients. 32 is elevated and it doesn't take much... I tend to think of it as the canary in the coal mine.******

That makes sense---and I probably won't worry about it too much.

Cheers,
Rita

James, 12, Adrian, 10, Elisabeth, 3, my babies!

Hi Rita, I've only had two bouts of irits, once in 1997 that helped me get diagnosed with AS (my eye doc called it) and once in the last year while under stress...each time I did prednisone eyedrops, and recently the flare required more frequent drops...I don't think I ever had ESR tests...and I went to the docs that knew iritis each time...

Now I have a weird floater in my left eye, like watching an ameoba swim over your eye while blinking...strange...my eye doc couldn't see it...will keep on it...

Do what you think, and your doc thinks, should be done, and don't hesitate to get a second opinion if necessary...
Peace
Linc

Hi Rita,

Sorry to hear about your long bout with iritis . . . I can really sympathize, as I too have battled it almost continuously for the past two years with the exception of a brief, four-month break at the end of last year and into this year. I am currently on the second bout in my right eye since my March cataract surgery on that eye, and those two bouts were separated by one in the left eye!

Has your optho told you about and/or used steroid shots to the lower eyelid yet? This has worked for me--well, it's worked in a way, It has stopped each attack in its tracks and knocked it out while no doing as well as it should to stop recurring attacks for at least six months. One shot did account for that four-month iritis-free window of time I mentioned above, but it is supposed to do more than that. Still, the shots (usually kenalog, once depo-medrol did do a very good job of knocking down an active flare each time and got rid of it faster than the eye drops alone ever did. I did not hear of these shots until my regular optho of many years finally decided to send me to the Retina/Uveitis Clinic at the Kellogg Eye Center at the University of Michigan. The docs there were surprised I'd never had a shot and use it as a primary weapon in my constant battle.

There is also a relatively new product called Retisert that is showing some good results, although it is a more drastic step that is only used in very tough chronic cases. Retisert is a tiny steroid "wafer" that is surfically placed in the eye. For the next two years, the wafer releases a small amount of the steroid directly into the retina. Because the surgery is not an option to be taken lightly, my doctor has said it will be a while before he will consider it with me, but he also said they are having good results with it. One of the big pros in favor of its use is that, quite simply, it guarantees a daily dose of steroids, whereas most patients told to use eye drops end up forgetting to use them so often that they render them ineffective.

Anyhow, thought I would at least mention these options in case you hadn't heard of them. If you (or anyone reading this) wants some more information on my personal experiences with the steroid shots, just send me a PM here.

Good luck,

Brad

My ESR has never gone above 28 (that I know of), even when in full flare or full blown iritis. So, the two don't track with me either.

Hugs,