Kickas.org Forums Treatments, Drugs and Alternatives Anti TNF and other biological medications Remicade & iritis?

Hi all,
I'm suffering from my first ever iritis attack. Had it now for around 4 months, I am taking Pred drops. My iritis has improved, but now a lower persistent/chronic level.
Have seen a specialist a few times, but she has offered me no further treatment, apart from my drops. My pupil is also slightly dilated, compared to the other eye & that has always been the case, as from the start of my iritis flare. I know iritis can affect around 40% of us AS'ers.
Could it be possible that Remicade could cause eye probs? As I've now been on Remiacde for around 5 years or so. Have read somewhere that there may be a link to iritis & Enbrel.
Also the Remicade doesn't seem to be working as well these last few months.
Many thanks.
George.

I get iritis, my last bout was last Chrismtas and lasted a month roughly. Anyway, I was on Remicade at the time, as far as I know this is supposed to help with iritis....I got it anyway.

This probably does not help much, sorry.

Amy:)

Amy,
Thanks for your reply.
Yes my iritis is prob related to my AS, but not knowing for sure doesn't help. Especially when my condition seems to be chronic now. Not knowing, I find one of the hardest things to deal with, when suffering from AS related issue's. Even the so called specialists often can't give use the answers we need to know.
Best wishes.
George.

Remecade or other biologics can help with Iritis but I have never expererience the drugs causing Iritis. You need to see a Rheumatologist or an eye specialist that also specializes in autoimmune disorders. I was lucky enough that both my doctors would tolerate one another. It works better to get a doctor who specializes in both fields. As far as your eye dilated that can lead to a permanent condition. Over a prolonged use the drops can do as much damage as the Iritis. You need to get a precise diagnoses like what is casing the pupil to be larger. Is it sticking to the lens or other internal structures of the eye. Is the eye no longer responding to light or less so. Watch for acute glacoma. Mine was finally treated with Humira and the drops or shots never had an affect.

"Because of the relationship between Uveitis and over 90 different pathogens and autoimmune disease processes we suggest that individuals with recurrent or chronic uveitis be treated by an Uveitis specialist or Ocular Immunologist. One may have to travel to see one of these very rare specialsts but by doing so, the health of the patient as well as long term positive outcomes for the uveitic eye will occur. some of these consequences to lack of treatment or under treatment are: epiretinal membrane formation, cystoid Macular edema, cataracts, Glaucoma, detached retina, Vitreous hemorrhage, and vascularization of the retina."

Tim

Tim,
Thanks for your reply & info.
I have been to see an consultant ophthalmologist whom specialises in iritis 3 times now, he has checked my pupil & said it was responding to light & dark conditions, but couldn't tell me why it was larger than the other eye.
At the moment, all my specialist will offer me is pred drops. I've been taking them for over 3 months now, with some eye improvement. Seems to be at a lower chronic level now.
As far as I can gather the closest ocular immunologist is over 200 miles away from me.
My AS has also seemed to have flared over the last few months too, whilst on Remicade. I am on a lower than normal dosage level at the moment & have been for around 5 years, due to previous elevated ALT's whilst at the normal dosage level.
I may ask my rheumy dept for advice & see I can now increase my Remiacde dosage level slightly, hopefully that will improve my iritis & AS..
I am also unable to tolerate long term use of any NSAID's, due to related stomach probs.
I was not sure which way to go really, but as you've stated Remicade prob hasn't caused the iritis flare. More likely my due in part to my AS.
How long did you suffer from iritis for? Was it chronic? Unfortunately here in the UK treatment is very hit & miss. Doesn't seem to be any communication between my eye & rheumy departments.
Best wishes.
George.

The last time I had Iritis, which was several years ago, my eye doctor gave me drops to keep my eye dilated (less pain) and I think the other drops were a corticosteroid. He also had me to wear sun glasses all during day light hours. It took about a month to heal, but at the start it was blood red.

Hi George:

I only had iritis once, years ago, but it was really bad. Went on for months too. When prednisone drops weren't helping enough, they gave me a choice, consider trying the oral prednisone drops, or get an injection directly into the eye area. (Yes I know). I went for the latter, because I was told there would be less side effects that way. Fortunately, it did the job, took a few weeks, but I did get better.

Sounds like your current attack isn't quite that bad, (not that it isn't serious) and hopefully you won't have to go the same route I did. And I sure hope Remicade isn't a contributing factor, I'm considering starting treatment soon!

Hi George,... I am sorry to read that you have not recovered from this attack of iritis yet. Four months is an awfully long time. I used to get attacks lasting this long and starting up again nearly as soon as it had cleared, prior to getting the diagnosis of 'chronic iritis'. I suppose it is impossible for anyone to know whether your case was induced by remicade or whether remicade was not controlling things well enough to prevent it. It is frustrating not to have solid answers yet on these critical things. I hope your Rheumy can advise you on whether or not to increase your dose. Hopefully your ALTs won't be raised again.

I could not find anything much about adults, and nothing specifically related to AS but you might find these following abstracts from PubMed interesting.

Recurrent new-onset uveitis in a patient with rheumatoid arthritis during anti-TNFalpha treatment

Risk of new-onset uveitis in patients with juvenile idiopathic arthritis treated with anti-TNFalpha agents.
"CONCLUSIONS: In our patients with JIA, anti-TNFalpha treatment did not alter the risk for development of new-onset uveitis. However, anti-TNFalpha therapy with etanercept did not prevent the development of uveitis in 2 patients."

Tumour necrosis factor alpha inhibitors in the treatment of childhood uveitis.


I had one pupil that remained just slightly more dilated than the other for a few years but did eventually return to normal, or close enough that if there is any difference now it's barely perceptible. I really hope you will find a way to get this very long attack to finally be over. If you do choose to increase your remi dose I hope you will post to let us know how you fair with both your AS and iritis.

My best to you!
mig

Hey George, you've already heard from our iritis expert (Mig), so all I can add is my commiseration and sympathy. I hope it clears up soon.

Warm hugs,

Mig,
Thanks for for kind words of wisdom & info.
Iritis still about the same at the mo, 5 months on. Still taking the pred drops (every 4 hours). Also right pupil still larger than my left one. I'm seeing an eye specialist ever month & she doesn't seem to have any answers. I just can't believe how persistent this attack is, considering it's my first. Did you find any treatment beneficial? What was your longest attack?
On the more positive note & had a word with the head Anti TNF nurse in my rheumy dept recently & he has said that they may be a chance of me starting Humeria. He also stated that Humeria may be more beneficial to my irits than the remi. If I get the chance, I shall give it a go.
I shall keep you posted to how I get on.
Many thanks & best wishes.
George.