WHEN TOPICAL MEDICATIONS JUST AREN’T ENOUGH

Title WHEN TOPICAL MEDICATIONS JUST AREN’T ENOUGH
Author, Co-Author Martin Copeland, Evan Canellos
Topic
Year
2004
Day
Program Number
Poster 153
Room
Affiliation
Abstract BACKGROUND: Psoriatic Arthritis (PsA) is a Spondlyoarthropathy; ocular findings include conjunctivitis and uveitis (Gladman 1998). Our patient EZ demonstrated a case of unilateral uveitis OS with a history of bilateral, recurrent, severe uveitis that had formerly failed to respond to topical or oral steroids. He was later prescribed oral cyclosporine. EZ responded well to cyclosporine but its use created liver failure. As a result, EZ was given Etanercept (Enbrel-Amgen, USA) an anti-rheumatologic. Even though the literature seems to indicate that Enbrel can precipitate uveitis, we found that EZ had fewer episodes of uveitis than he had in many years. Unfortunately his current bout of iritis required us to again treat him with more than topical medication

CASE REPORT(S): 60-year-old white male, presents with redness OS for 5 days. No pain, discharge, photophobia or injury/trauma. DVA 20/30 OD,OS. Patent PI OD. History is positive for PsA with recurrent bilateral iritis. Currently taking Enbrel. SLE reveals fine KPs OS, D/Q OD, 2+ cells. 360 posterior synechia OU with scarring and destruction of the iris margin OU. IOP(mmHg) 10/9@9:00AM. PredForte was initiated q2h OS and Cyclogyl qid OS. No changes to systemic medications. After two days with compliance. No change to the AC reaction or KPs observed. Upon consult with Rheumatology, oral prednisone 40mg was added to the regimen. After 7 days, pain still denied and SLE showed dark KPs, a sign of resolving inflammation. At 17 days we saw significant improvementCONCLUSIONS: As evidenced by this patient, Enbrel used as monotherapy for patients with PsA may be able to control inflammation both systemic and ocular, for an extended period of time. Interestingly, uveitis did not present in this patient during the entire course of Enbrel until this recent episode. Curiously this episode was asymptomatic and relatively mild in nature. However it was slowly progressive and unresponsive to maximal topical therapy. In this case it remains to be seen if this is another episode in the long list of recurrences for EZ or an isolated episode precipitated by Enbrel
Affiliation of Co-Authors State University of New York, College of Optometry
Outline