cataract surgery and prednisone dose and Actemra infusion

[Kt1943]

Hi again everyone. Last time I posted I had had a relapse of the GCA after having to pause the Actemra infusions due to pneumonia and sepsis. I am now back on Actemra (had my first infusion last month) and back down to 15 mg prednisone from the increase to 30 mg when I had the relapse. I have just found out that the prednisone related cataracts have increased to the point where I need to get both eyes operated on as soon as possible as the right eye is to the point where the ophthalmologist says if they don’t do the op soon, they wouldn’t be able to fix it. I am hoping to get it done in December. My question is should I stay at the same dose of prednisone till the op is over (I had been told I could go down again soon) and also with the infusion I think I have to allow a certain amount of time before and after the op before doing the next infusion. Any thoughts on this would be appreciated. Thanks.

[PMRpro Ambassador]

The dose of pred an eye surgeon will accept depends on them. There is no reason to stay at your current dose if you don't need to so I would taper if you want to. You should speak to the specialists about the timing of the Actemra infusion. No-one here is likely to have the background knowledge for that.

In some references they say a month - but more recent sources are suggesting that a week is plenty and that protracted discontinuation has the disadvantage that the patients relapse. Only the eye surgeon and the rheumatologist are likely to know what their policy is.

[Kt1943 in reply to PMRpro]

Thanks so much. Will keep trying to get hold of rheumatologist’s office … not having a lot of luck at this point!!

[Missus835]

It would be up to the Ophthalmologist, but I had both eyes done in the Spring (separately) with no change in my dose of Pred. When I had one done the difference was amazing and the undone one was as if looking through gauze. After both, I only need cheap reading specs. You won't regret it. Best of luck.

[Kt1943 in reply to Missus835]

Thanks for the reply

[julesster22]

you need to stay at high levels until you feel comfortable to lessen. Any issues with liver levels or white blood cells level