When 63-year-old Greg Cook's right cheek suddenly went numb last March, he felt a few moments of unease but thought the 10-minute episode could be related to recent dental work. He didn't call his doctor.
Ten days later, he lost feeling in his right arm for about 30 minutes. That day, he did see his doctor, who heard a "bruit" in his carotid arteries, a whooshing sound that suggests reduced blood flow, and sent Cook, a retired magazine editor living in Bethlehem, Pennsylvania, straight to the emergency room.
Cook had arm and leg weakness, and this, along with his earlier, recurring symptoms, led vascular surgeons to suspect he'd had at least two transient ischemic attacks (TIAs),or mini strokes that generally resolve in less than a day without causing permanent damage.
A CT angiogram revealed 90 percent blockage in his left carotid artery. Dr. James Balshi, a vascular surgeon and medical director at The Vascular Center in Bethlehem, told Cook the blockage in his artery and results from a brain MRI, which showed three pinhole-sized areas of permanent but still-limited damage, meant he needed urgent surgery to avoid a major stroke. That evening, Cook underwent a left carotid endarterectomy, a procedure to remove blood flow-blocking plaque.
His only stroke risk factors were the psoriasis and psoriatic arthritis he'd been diagnosed with in his 40s. Cook believes the rapid diagnosis of his symptoms and the ensuing surgery saved his life, and he's since recovered with no lingering problems.
Stroke is one of several conditions, called comorbidities, that occur more often in people with psoriasis and psoriatic arthritis.The common denominator is the body-wide inflammation characteristic of psoriatic disease.
Here, experts explain the symptoms of stroke,the eye condition uveitis and gum disease, common comorbidities of psoriasis and psoriatic arthritis, and steps you can take to lower your risk.
People with severe psoriasis have almost three times the risk of stroke compared with those without the skin condition. Plaque build-up and the resulting narrowing of arteries (atherosclerosis) is a major cause of stroke and is increasingly linked to inflammation, said Dr. Jashin J. Wu, director of dermatology research at the Kaiser Permanente Los Angeles Medical Center and a member of the NPF Medical Board.
"People with mild psoriasis have a lower, but still increased, risk of stroke, and people with psoriatic arthritis also have higher risk than the general population," Wu said. "Those who also have traditional stroke risk factors —being overweight or smoking and having highblood pressure or cholesterol or diabetes —are at even greater risk."
Balshi said people who have stroke risk factors should consider discussing the pros and cons of tests to evaluate their risk.
Stroke and TIA symptoms include:
- Sudden numbness, weakness or paralysis on one side of the body
- Trouble walking, dizziness or loss of coordination
- Trouble speaking or understanding speech
- Blurred, darkened or double vision in one or both eyes
- Sudden, severe headache
If you have any of these symptoms,call your doctor immediately, or go to the emergency room. If you are treated within two to three hours of a stroke, you're more likely to survive the event and avoid long-term problems.
- Visit your doctor annually, and ask for an evaluation of stroke risk factors
- Work with your doctor to improve the factors you can change through losing weight, exercising,quitting smoking and managing high blood pressure, blood sugar and cholesterol
- Discuss systemic therapies for psoriatic disease with your doctor. Studies show treatment with tumor necrosis factor-alpha (TNF-alpha)inhibitors lowers heart attack risk, and Wu says it may also reduce stroke risk, although more research is needed to confirm this
Although researchers don't yet have a complete picture of the relationship between gum disease and psoriatic conditions, studies have shown people with periodontitis (severe gum disease) are about 1.5 times more likely to develop psoriasis than people with healthy gums, said Dr. Zelma Chiesa Fuxench, a dermatologist at the University of Pennsylvania Perelman School of Medicine in Philadelphia.
Additionally, a 2013 study published in the journal Inflammation found that while people with psoriatic arthritis had about the same rate of gum disease as those without joint inflammation, people with psoriatic arthritis were more likely to have severe gum problems.
"Some experts say that, based on preliminary studies showing an association between psoriasis and gum disease, patients with psoriasis should be closely followed by a dentist for screening and possible early treatment," said Chiesa Fuxench.
Gum disease symptoms include:
- Red or swollen gums
- Bleeding while flossing, brushing or eating hard foods
- Receding gums
- Loose or spreading teeth
- Persistent bad breath
- Floss at least once a day
- Brush after every meal and before bed
- Swish with mouthwash after brushing
- See your dentist twice a year, and consider asking for a comprehensive periodontal examination to help identify early gum disease
Uveitis is inflammation in the eye that can affect different parts of the eye and,like psoriasis and psoriatic arthritis, can flare and then go away, or become chronic.Recurrent uveitis can sometimes lead to vision loss, although this is uncommon, said Dr. James Rosenbaum, a rheumatologist at Oregon Health & Science University in Portland and head of the Uveitis Clinic.
Patients with psoriasis are slightly more likely to have uveitis than healthy people,while those with psoriatic arthritis have a much higher risk, he said.
"About one person in a thousand in the general population develops uveitis; for those with psoriatic arthritis, it's closer to 70 in a thousand," he said, adding that those with joint inflammation in the spine are most likely to have episodes of uveitis.
Uveitis symptoms include persistent:
- Eye redness or pain
- Sensitivity to light
- Vision changes
- There aren't many strategies for preventing uveitis, but Rosenbaum said that treating psoriasis or psoriatic arthritis with systemic medications such as sulfasalazine or TNF-alpha inhibitors often reduces uveitis flares.
Driving discovery, creating community
For more than 50 years, we’ve been driving efforts to cure psoriatic disease and improve the lives of those affected. But there’s still plenty to do! Learn how you can help our advocacy team shape the laws and policies that affect people with psoriasis and psoriatic arthritis – in your state and across the country. Help us raise funds to support research by joining Team NPF, where you can walk, run, cycle, play bingo or create your own fundraising event. If you or someone you love needs free, personalized support for living a healthier life with psoriatic disease, contact our Patient Navigation Center. And keep the National Psoriasis Foundation going strong by making a donation today. Together, we will find a cure.