Which treatment is best for eye problems?

Hi everyone. I'm posting on behalf of my 75 year old father who was diagnosed 10 years ago with RA. Since that time, he has been treated intermittently with prednisolone and sulphasalazine but he has never had the disease fully under control. He prefers minimal amounts of treatment. The dry eyes of the secondary Sjogrens has been treated by blocking the tear ducts but he has repeated bouts of iritis and scleritis which need in-patient treatment and have claimed most of his sight.

A recent review by his often inconsistent rheumatologist has changed his dx to sero positive Palindromic Rheumautism (despite joint erosions) and she recommends either Methotrexate or Rituximab as the best treatments for his eye problems. My father doesn't accept this argument for such toxic treatment without supporting evidence - has anyone else been told this or, better still, been treated successfully for the same symptoms?

Thanks for reading. Clare

6 Replies

  • Hello

    With the types of medications your Father takes they can suffer quiet severe side affects especially as when we get old.

    I see He is taking DMARD medications and now they wish to put Him on -TNF Biologic medication. The treatment is sound although both medication types can affect the White Blood Cells and reduce the immune system.

    There are people on these types of medications and they can reduce changes to your Fathers joints.

    Only you and or Father can really say that the treatment is going to be beneficial at this time of life. I am unable to advise so if you are not sure ask your GP and approach the RA Nurse and ask her the best way forward.

    I suffer PSA and I am unable to take DMARD type medications, that stops them trying any type of Biologic medications, I was last seen by a Specialist two years ago because I suffer severe contraindications. I was thrown out of the clinic because I would not take any of these cancer treating drugs

    You need to take advise, I am sixty five



  • Thank you for your thoughts, Bob. My father is a retired Dr himself (they make the worst patients!) so he questions the need for all medications/treatments. He is not an expert in auto-immunity however and never uses the Internet so remains highly suspicious of his Rheumatologist.

    Thank you once again. Clare

  • If you loose the right to question how can we trust those who are in partnership with ourselves and try and do no harm.

    We also need to be able to make informed choices on what we are offered.


  • There seems to be quite a lot of evidence for treating chronic iritis/uveitis with antitnfs, with infliximab being the one that seems to come up more often.

    I'd probably want a second opinion on the rheumatology though - iritis far more often goes with spondyloarthritis than RA (30-40 percent of people with ankylosing spondylitis have iritis, and AS is commonly first spotted or suggested by opthalmologists dealing with repeated iritis). It matters what the diagnosis is because it will lead to different treatment choices. See if he can be seen by a spondyloarthritis specialist if you can - aside from the fact that his RD diagnosis has been changed, a spondy specialist will be far more used to seeing iritis and knowing how to deal with it properly.

  • Thank you so much for this information, Earthwitch. I have lupus/UCTD myself but have absolutely no knowledge of the Spondylarthropathies. How do I find a Rheumatologist who specialises? We are in the South West so Bath centre of Rheumatology springs to mind. He's not against the biologicals as such but needs evidence that this is the way to go.

    I will pass on your comments to him. Thank you once again. Clare

  • The Bath Centre would be an excellent place to go if you can.

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