I was listening to the news on the radio over the weekend and there was a report regarding how not brushing your teeth twice a day could increase your chances of having heart problems (heart failure/attack). It was interesting to hear how they think the two are linked, however it suddenly made me wonder if this could have sparked my recent flare up of Iritis... Please bear with me and I'll try to briefly explain.
Not keeping your teeth and gums healthy can lead to a greater risk of infection of your gums (obviously). The resulting infection causes inflamation inside the gum and aparently it is this inflamation which can then get into the bloodstream and cause issues with arteries and the heart muscle etc. Now although I brush twice a day, I have wisdom teeth that have not fully broken the surface and a week or so ago I have a painful area of gum that was also swollen and a few days after that I got my old friend Iritis back again after just 10 weeks of being free of it.
Obvoiusly ignoring the fact that my inflamed gum could be hurtling me towards a massive cardiac arrest Could this potential inflamation of my gum have triggered Iritis? I suppose if the immune system detects the inflamation cells then it could trigger a response that would also trigger Iritis?
Am I clutching at straws here (healthy gums = less Iritis), or do you think there is actually some reason to it? I apologise if this is already common knowledge.
Inflamed/infected gums can cause bouts of Iritis/Uveitis. Anything that causes bacterial infection- hence stress on your immune system, can cause a flare. This is not necessarily common knowledge. DOn't ever apologize for asking a question. The only dumb questions are the ones not asked, especially for fear of ridicule. You are not grasping at straws. In addition to getting your eyes cared for, try to find a dentist. Some localities offer a low-cost dentist, or a medical/dental school near you may offer reduced fees. Call your local Health department for more info. Get your teeth cared for.
depending on the pathogen involved in the gum disease it MIGHT cause uveitis to occur. if you have a history of uveitis prior to the gum disease, the new infection could cause a renewed bout of iritis to occur. the inflammatory processes of gum disease and uveitis share what are known as cytokines. these cytokines are given off by the immune system in many conditions which can cause uveitis to occur as a consequence.
I thought it was an interesting article and it seemed to ring a bell with my current flare up.
To answer your question Mike, yes I do have a long history (over 15 years) of Iritis. It only ever occurs in my right eye, although the doc once said that he thought that I had gotten Iritis in my left eye previously but it had sporadically healed (I didnt know it could heal itself?)
I have also suffered from Psoriasis for just as long - if not longer, but it has always been relatively mild (patches on elbows, knees and on ankle mainly). I assume that this is probably the main reason I get Iritis, although the doc I saw last said the doubted this was the case. I'm not sure I believe him as Psoriasis and Iritis is well documented and it is the only thing that seems to be related to my condition.
Up until Oct last year I had not had Iritis for 5 years, but recently I have been going through a bad patch where I have only had between 1 and 10 weeks break between flare ups. I find it frustrating to know that almost anything that causes my immune system to become more aggressive, can cause a flare up, and thats not taking into account my costant Psoriasis.
Is it normal to go such a long time between flare ups but then to keep getting it almost one after another?
Thanks again for your support, it's good to know there are people who understand and dont look at you like a leper.
your very long history of uveitis as well as psoriasis is most likely linked. often the HLA B27 gene seen in both conditions is the cause, triggered initially by a virus, bacteria etc. then later on it can be re triggered by a new bout with a virus or other pathogen. the immune system becomes hyperactive and then attacks the eye by mistake as well as any other tissue that has this gene present. down regulation of the immune system is required for it to stop making the white blood cells targeting our tissues by mistake. the first step would be to employ NSAIDs such as celebrex, dolobid, naprosyn etc orally in an attempt to accomplish the goal of 'off all steroids without inflammation'. if after six months and no cells present, then one would continue for TWO YEARS at this dose of NSAID. then the daily dose would go to half and after six months stopped.
if the NSAID didn't keep the eye quiet, then DMARD drugs such as Methotrexate would be initiated by the Ocular immunologist/uveitis specialist. often a rheumatologist is involved in the monitoring of side effects of these drugs.
moderate to severe psoriasis is now treated with the drug Stelara which can also treat the inflammatory cytokine given off by the immune cells through the IL23R gene implicated in many autoimmune diseases and uveitis. a new experimental drug is now being used that blocks the IL17A cytokine controlled by the IL23R gene and it is showing promise in preliminary studies. the IL23R gene is implicated in Psoriasis and after about 15 years of psoriasis it can turn into psoriatic arthritis. this type of psoriasis usually causes swelling of the index finger and great toe. nail discoloration is also found in psoriatic arthritis. psoriatic arthritis is also one of the seronegative spondyloarthropathies which can impact joints of the pelvis and spine similar to that found in ankylosing spondylitis and reactive arthritis. sometimes there is Gastrointestinal complaint in the form of Crohn's disease and ulcerative colitis. incidence of Celiac disease can be found as well.
Psoriasis definitely causes Iritis and other forms of Uveitis as well. If you can bring the Psoriasis totally under control, you can bring your Iritis to remission. Iritis/Uveitis does NOT heal itself without proper treatment. I wish I'd known that a lot sooner; if I had, I would still b e driving and not have gone on SOcial Security. Now that I am taking Humira- which by the way, is approved for use of Psoriasis, and the best off- label use (or at least my favorite), is bringing Uveitis under control.
What medication are you on for Psoriasis?
Yes, unfortunately, society does treat anyone who is different in some way much like a leper. They fear what they do not understand. Our job as folks with Autoimmune processes that are obvious, like yours, or as Visually- impaired/ blind folks, is to teach those we meet that we are just like them, but with a quirk or two. YOu cannot reach everyone, but if you reach someone, then they will spread the word, and you will have made your corner of the planet that much better because you educated someone out of their fear. I have done it. I find also that if I put the extra effort into my appearance, people are more accepting and friendly, rather than avoiding me and staring at me. That's just me- the way I live my life will not work for everyone, but I share things now and then because they might help. I believe that all of us are in this fight together, and if we will support one another, and learn about our diseases, then the battle is already half- won.
Hi Mike,
Because I only used to get Iritis about once a year, or at its worse I was getting it about every 6 months for a couple of years, I didnt really push any other treatment. I was happy to just go to the hospital, take my drops and then get on with life until the next flare. I was quite ignorant of the situation, and because it was only a brief disruption to my life I suppose I was happy to keep the status quo.
However, as I am now getting almost continued bouts with very little rest in between flare ups I have come to realise the importance of getting off these damb drops! When I next visit the eye doc I will ask about getting onto NSAIDs. I have taken so many drops recently I'm sure I am starting to look like a Maxidex bottle!
Although my Psoriasis is relatively mild it still affects my confidence. I will not wear shorts and I am concious of my elbows when I wear t-shirts, I want to shout "I am not infectious!" to people who stare. I have always wondered about psoratic arthritis as although most of my joints are fine, I do sometimes have a painful wrist that comes and goes and I also have pitted fingernails which I think can be an indicator of possible (or future) predisposition to psoratic arthritis.
Thank you for your words of reassurance mtbargeman. Other than various types of steriod cream and moisterisers, I am not on any other kind of medication for Psoriasis. Is there anything I should be considering?
I would suggest asking about a DMARD drug first, (one of the more common ones for Psoriasis is Plaquenil) and if it did not work, ask about Humira. It is an injection, taken every other week. It is extremely common to get a little rash or swollen area around the injection site. Take some Benadryl about an hour before injecting, then again 3 hours after if you get a reaction anyway. It makes the injection site feel better.
Many folks find that a little sun helps their Psoriasis, also, but since you also have a potentially vision-robbing condition, see a Rheumatologist, and get yourself some immuno-suppressive therapy tailored to your needs. Make certain your eye guy talks to the Rheumy, and vice versa. This is important, because some drugs used to treat Joint disorders and Psoriasis will actually cause Uveitis. I like Humira. It has saved what vision I had left, and gotten my traitorous body under control, so that I can write- I just got a long term contract to write articles for a personal care product company- and I will soon sit for the exam to once again become a Nurse Aide. It's been a long hard road to get where I am today, and had I gotten treated much sooner, it would not have been so hard. It doesn't have to be so hard for you- please, get treatment. Fight tooth and nail and boot and heel. And call me Mary.
with your history of uveitis, Stay away from plaquenil, it does NOTHING for uveitis and risk of optic nerve damage is great.
usually methotrexate is tried first for both uveitis and psoriatic arthritis. then they add remicade or humira to the mix. there are other types of biologicals they can use too. Stelara would be my choice if the rheumatologist would allow it as it stops IL23gene from producing IL17 the inflammatory cytokine which is present in both. steroid creams can help the psoriasis as can UV activated creams. if you can get Professor William Ayliffe in London as your opthalmologist, it would be wonderful for you. Professor Murray in Bristol and Professor Forrester in Aberdeen are options too.
I will definitely try to arrange a meeting with a specialist, Bristol is probably the best for me.
Flying off at a bit of a tangent here but I have an odd question for you.
Have you had anyone mention odd side effects with taking eye drops (primarily Maxidex)? I am asking this because although I have been taking Maxidex drops on and off for 15 years, it is only recently that I have been using them almost continuously and I have recently (about 8 - 9 months ago) started smelling smoke when it's not there. I smell it everywhere, I dont smoke, noone I know smokes, I am not in contact with it in any form.
I am wondering if this is linked to the eye drops as I have had been on Maxidex almost continuously since October 09 which is the longest time I have ever had to use them. Unfortunately I cant remember if I started smelling smoke around the time I got Iritis, but I think they started not too far away from each other (but I could be wrong). The smell isnt constant, it comes and goes, sometimes I will smell it for a whole day or two but then it could go for a few days or even weeks, (again, not sure if the smell goes when I'm not taking drops) then it comes back. Sometimes I get it and can smell it on and off throughout the day, but I have found it hard to specifically link to the drops but that is the only constant I can think of. It is only recently that I have thought that the drops could be a cause as I have been looking at other causes instead.
I have spoken to my doc who looked at me blankley and then guessed at what the cause may be. His only consolation to me was to say he didnt think it was anything bad causing the smell, i.e. brain tumor as I wasnt having any other 'red flag' symptoms. He mentioned Maxidex as a possible cause but again he was just guessing.
It is strange one I know but I thought I would ask.
That's a new one to me! you could ask an Ear, Nose and Throat specialist. try occluding your punctum while instilling the drops. press in over the inside corner of your eye after putting the drop in and hold this for about 5 minutes to make sure the eyedrop is absorbed and doesn't go down your sinuses. this also prevents the awful taste of the corticosteroid as it goes down into the throat and mouth. this should stop the sensation if it is the eyedrop I would think.
When I used steroid drops alot a few years ago, I often noticed strange smells. I cannot recall if Maxidex is a steroid or not. I do recall having strange smells come to my nose, tho, with many drops and some pills I have had to take. I have not noticed that there was anything dangerous going on; some folks just have a bit of an extra-olsensory experience in certain situations. For example, when I took Cyclosporine, I smelled skunk for a couple of hours after I swallowed the pill. When I stopped the drug, I didn't smell it again. Methotrexate - I smelled an odd chemical odor every Friday night, and all day Saturday, as I took it once a week. Different people notice different things, and as long as your doc doesn't think there is anything wrong with your brain, about all you can do is follow Mike's advice to plug your tear ducts when taking drops, and light some incense. I don't think you are any weirder than I am.
Mary
Could this potential inflamation of my gum have triggered Iritis? I suppose if the immune system detects the inflamation cells then it could trigger a response that would also trigger Iritis?