intermediate uveitis and ms

[sara1953]

I'm new to this site and to MS and I have some questions. Does anyone out there have intermediate uveitis and MS? I am currently trying to treat both problems: the MS with Avonex and the IU with Cellcept. I was dxed with the uveitis in 2003 and got the MS dx this past fall. I've been trying to find out any connection between the 2. Other than the fact they're both autoimmune proccesses I'm at a dead end. I have had some great success treating the uveitis with a combination of methotrexate, cellcept and humira but I am hesitant to mix all of that with the avonex. (My poor liver probably would curl up and die!) I have also found that Humira aggravates the demylenating in the brain so that drug is definately out. Any insight or suggestions would be appreciated. Thanks Sara

[Redwings]

Hi Sara:
There's a subset of people with MS who are prone to uveitis, particularly pars planitis. The incidence has been cited to be as low as 1% but generally as high as 10 to 15%. The Ocular Inflammation and Uveitis Foundation has a report that has the incidence as high as 27%, but there seems to be few sources that support that figure. My own neuro-ophthalmologist is also a specialist in ocular inflammation (he treats all of the people in my medical group in this area who have chronic/recurrent uveitis) and he says he's never seen the incidence to be that high. So you'll have to research it and decide for yourself. There's ample evidence that MS and forms of uveitis are related -- it's the incidence that there's not perfect agreement about. The Uveitis Foundation case report says that the incidence of MS in people who have uveitis (the other way around from uveitis in MS) is as high as 14%.

Good call on stopping the Humira, for the reason you mentioned. Cellcept isn't known to affect the liver, so theoretically it should be OK to take with Avonex. But that isn't absolute. Cellcept did cause my liver enzymes to rise, which is one reason I had to stop taking it. Methotrexate is the med you've been on that's known to affect the liver, so you have good reason to be careful with watching your liver function.

If need be, there are some other immunosuppressants for you to try later. Your doctor should be able to advise you if the time comes that you need to change meds. But there's no need to worry about that unless the time comes.

[sara1953]

thank you

Thank you so much for your quick reply. Amazingly I am in CA also. We have tried other immunosuppressants but I had adverse reactions to them. After my eyes being relatively quiet I am flaring again. I also have had a go-round with ON. The uveitis has brought with it all the complications and various injections and surgeries. I am very concerned about keeping my eyesight. If it comes to the point where I have to choose between treating my eyes or the MS I'll go with my eyes and take my chances with the MS. If I may ask, who is your neuro-optho? If it's not proper to give out dr's names on this site I can give you my email. I would love to be able to get another opinion. I did make a couple of trips to the national eye institute in Bethesda in 03 and 04 but it's easier for me to travel within CA these days. MS and long flights don't mix well. I will make an exception for Hawaii tho! Thanks again Redwing. Sara

[redheadRA]

Sara-- The key could be in the inflammation of the blood vessels of the uvea. The connection to MS may lie in the elevated levels of Homocysteine, which is a potent blood vessel toxin. MS patients have been shown to have elevated levels. So have patients with Behcet's disease and associated Uveitis. Do a google search on Homocysteine and Uveitis. I found numerous studies that show an association. You can also go to the threads titled "High Calcium" and "MS Fatigue Causes" and "Headaches" here to learn more about Homocysteine and MS.

I thought Redwings response was very informative. I didn't realize what a strong connection there was.

[Redwings]

If I may ask, who is your neuro-optho?

Hi Sara:
My neuro-ophth works -- hard to believe -- for an HMO, so unless you have the same HMO you won't be able to see him. BUT... the great neuro-ophth I've seen outside my HMO was also the mentor of my current doc, and I'm happy to recommend him to everyone! He's Dr. Alfredo Sadun at the Doheny Eye Institute in LA. I first saw him almost 20 years ago and he immediately identified my ON as not typical of MS, which turned out to be critical to my treatment many years later.

Doheny also has a couple of specialists in uveitis/inflammation and would be great for another opinion. (I have not seen the uveitis docs.) Doheny acts as a referral center for all of Southern California. It's a teaching clinic, and the staff is made up of the teaching faculty of the USC medical school. So if you don't mind being examined by several practitioners at different levels, Doheny is definitely worth considering.

[sara1953]

redhead and redwing

Redheadra-Thanks for your suggestion about homocystiene. I will do some research and talk to my Dr at our next visit.
Redwing-Thanks for the info. You wouldn't be part of Kaiser by any chance? I've been very pleased with my treatment from my Dr but he is a uveitis specialist and is not up on MS. I'm looking for that miracle Dr who is well versed in both problems. I am familiar with the Doheny Eye Institute and it will be a good excuse to go down to some warm weather.
Thanks to both of you. Sara