Deans' stroke musings: Stroke Spike Seen in Autoimmune Disorders After Shingles Attacks

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Tuesday, November 10, 2015

Stroke Spike Seen in Autoimmune Disorders After Shingles Attacks

If I ever manage to be home long enough I'll get the shingles vaccine, but then I don't have RA. Be careful out there.
http://www.medpagetoday.com/MeetingCoverage/ACR/54580?
Patients with an autoimmune disease, such as rheumatoid arthritis (RA), have a significantly elevated risk for having a stroke within a month of developing herpes zoster, researchers reported here.
After adjustment for multiple potential confounders, the incidence rate ratio for autoimmune disease patients being hospitalized with an ischemic stroke within 30 days after developing herpes zoster reactivation was 1.50 (95% CI 1.06-2.12) compared with their rate in subsequent years 2 to 6, according to Leonard H. Calabrese, DO, of the Cleveland Clinic, and colleagues.
The risk of stroke remained high throughout the first year after the shingles episode, with an incidence rate ratio of 1.30 (95% CI 1.05-1.61) compared with their risk in year 2, he reported in a plenary session at the at the American College of Rheumatology annual meeting.
"These data are important as we now live in an era of increasing concern over herpes zoster," Calabrese said.
Zoster is associated with significant morbidity even in its less serious forms, and stroke is one of its potential complications.
"Among patients with immune-mediated diseases on certain biologics and immunomodulators the rates [for herpes zoster] are extremely high. In general, we believe that patients in rheumatology practices have a 50% to 100% increased rate of herpes zoster," he said.
Previous studies have suggested that the risk of stroke may rise shortly after an episode of varicella zoster virus reactivation. In four earlier studies, hazard ratios for stroke ranged from 1.26 to 4.52, depending on the type of zoster, timing, and antiviral therapy.
However, little is known about the risk among patients with autoimmune diseases -- who have an elevated risk for both zoster and stroke.
Calabrese and colleagues analyzed Medicare data for the years 2006 to 2013 for patients with diagnoses of RA, ankylosing spondylitis, psoriatic arthritis, psoriasis, or inflammatory bowel disease plus a diagnosis of zoster and prescription for antiviral therapy within 1 week.
They identified 50,929 patients with an autoimmune disease plus incident zoster. Three-quarters of the patients were women, their mean age was 71, and 85% were white.
During the first 6 months after the zoster diagnosis, the crude incidence rate of hospitalization for ischemic stroke was 9.8 per 1,000 patient-years, while the rate in years 2 to 6 was 8.7 per 1,000.
The researchers also performed a subgroup analysis for more complicated forms of zoster.
Two-thirds of patients classified as having complicated disease had zoster of the head and neck. For the overall group and the more serious, complicated group, after adjustment for multiple factors, the hazard ratio for stroke was 1.6 in the uncomplicated group and 3.2 in the complicated group in the first 30 days.
The researchers also conducted a sensitivity analysis to see if prompt diagnosis and treatment might mitigate the incidence of stroke.
Among patients who had no antiviral therapy, the hazard ratio for ischemic stroke was 1.4 (95% CI 0.8-2.5) during the first 30 days, similar to the overall group, but this persisted and did not decrease in the subsequent 2 months.
"There was a 16% lower risk when antivirals were administered within 7 days," Calabrese noted.
He urged clinicians to advocate for zoster vaccination.
"There is now a new urgency for vaccination for zoster, as prevention of stroke may be an additional downstream benefit," he said. "Unfortunately, the herpes zoster vaccine has had a low penetration in the general population as well as among patients with immune mediated diseases, and effective measures are needed to increase vaccination rates."
Calabrese also supported the use of antiviral therapy on zoster diagnoses.
"Our data also suggest that prompt antiviral therapy may actually reduce the rate of stroke following zoster, and thus prompt diagnosis and treatment are needed more than ever," he said.
Limitations of the study included the use of administrative data, and a lack of information about stroke type and anatomic distribution.