Loreum Ipsum

Question

Although I was diagnosed with Pars Planitis a long time ago, I have not have any flare-ups since they first got it under control about 15 years ago, (that is until a couple of weeks ago.) I have been researching a lot in the past 2 weeks and have learned a lot, plus have tons of questions about my disease and treatment. Back then, I didn’t know that doctors should look for the “root” of the disease. I am assuming that since I don’t have anything like MS., etc. that mine is auto-immune related.

I see the optho that originally treated me on Monday and I am going to ask a lot of questions. Since I was only 16 at the time, I can’t remember him ever discussing pressures and severity of the inflammation. I do know that it must have been very bad because I had very limited vision when I was diagnosed, but I must have responded to the steroids well. I took oral prednisone (60 mg day), drops and injections. My lingering problems have been floaters and poor night vision, but they have gotten worse about 2 weeks ago, along with increasing blurriness.

I am going to be well-armed with information and a list of questions on Monday for the optho. I feel like I was just diagnosed, instead of years ago, because of all that I have learned recently. I think that anyone that has become inflammation-free should be seen by an optho every couple of years, even without having any symptoms. My optho didn’t recommend it after the first yearly check-up and looking back I don’t think that was a good idea. I haven’t seem him for 14 (??) years, just my optometrist.

Missy

Answer

Dear Missy:

HLA-B27-associated uveitis occurs, we think, as a result of some germ or other triggering an autoimmune response. Certain germs have proteins that “look” like part of the HLA-B 27 protein that is present on the surface of the cells of the body in patients who inherit the HLA-B27 gene. And if such a person has the bad luck to come into contact with one of those certain germs at some point in life, the person’s immune system will, of course, attack and kill the germ; but it may also then inappropriately begin to “see” part of the HLA-B27 protein as also being foreign or germ-like, and attack it too, producing damage to the patient’s own cells. This then must be treated, calmed down, with steroids, and if it keeps coming back again and again, other medications may be needed as well.

Wishing you all the very best,

Sincerely,

C. Stephen Foster, M.D.

Hello my name is Holly,

My biggest problem is that this [iritis flares] has been happening with my eyes a week before my period for over four years. Both flare-ups happened at that same familiar time. I have had all the blood tests twice now nothing conclusive. Also a colonoscopie because my grandmother had crones. I am 38 and a mother of four I don’t spend much time on myself I don’t have it. Though I have had to slow down. I am just starting to realize how serious this is. I feel like a sitting Duck.

Holly

Dear Holly,

Two things: 1. First, there can be a relationship between flare-ups and menstrual cycle/hormone level ratios. You can determine whether or not this is probably the case with you by charting basal body temperatures and keeping track of flare-ups on the basal body temperature chart; you will find basal body temperature kits in any pharmacy; it is a real pain to do it for, say 4-6 months, but if you are willing to invest the time and effort into that, you can then take the charts to your gynecologist, who could then order the appropriate blood test for hormone levels at specific times of the month, find out what imbalances you might have, and then prescribe hormonal therapy for you to properly balance the relative amounts of the various hormones in an effort to see if that would stop you from having the flare-ups.

Sincerely Yours,

C. Stephen Foster, M.D.