Galloway JB, Mercer LK, Moseley A et al.Association between vaccination for herpes zoster and risk of herpes zoster infection among older patients with selected immune-mediated diseases. Connect With Others In The Arthritis Community To Share Information And Support.Keep Current With The Arthritis Community Newsletter.People with immune-mediated conditions such as RA are also at increased risk of shingles. The condition can affect anyone who’s had chickenpox, but is most common in older people or those with a weakened immune system. Shingles causes a painful rash that usually develops in a single stripe on one side of the body or face. Shingles (also called herpes zoster) results from reactivation of the chickenpox virus. Although these drugs provide effective RA treatment for many people, they also suppress parts of the immune system and can increase the risk of infection. If this initial treatment does not adequately control the RA, patients may move on to treatment with a newer, biologic DMARD such as a TNF inhibitor. Treatment of RA often begins with methotrexate or another disease-modifying antirheumatic drug (DMARD). The condition causes pain, swelling, and stiffness of joints, and can lead to permanent joint damage. Rheumatoid arthritis affects an estimated 1.3 million adults in theUnited States. These results were published in the Annals of the Rheumatic Diseases. RA patients treated with TNF inhibitors may have a higher risk of shingles than patients treated only with traditional, non-biologic disease-modifying anti-rheumatic drugs. TNF Inhibitors May Increase Risk of Shingles Given this finding, it was proposed that alternative risk reduction strategies be developed for groups of patients for whom the shingles vaccine is not indicated. The researchers concluded that several autoimmune diseases and other chronic conditions significantly raised the risk of shingles. However, the shingles vaccine is contraindicated for these patients. These included patients with lymphoma, myeloma, and HIV. What’s more, patients with severely immunosuppressive conditions were at greatest risk of shingles. In addition, the relative effect of the risk factors analyzed was larger in younger patients. The team also found increased risk for shingles in patients with inflammatory bowel disease (OR = 1.36), asthma (OR = 1.11), chronic kidney disease (1.12), depression (1.15), and Type I diabetes (1.26). RA patients proved to have an OR of 1.46, while those with COPD had an OR of 1.32. Results of the study indicated that the OR for patients with lupus was 1.72. For example, an OR of 1 would mean that the autoimmune condition had no effect on the odds of the outcome, in this case, development of shingles. The OR is simply the odds that an outcome will occur given a particular exposure or condition. Specifically, the team calculated odds ratios (OR) for each autoimmune condition. A total of 65% of the cases were in patients younger than 70 45% were younger than 60.įorbes and her team used statistical analysis to estimate how closely associated the potential risk factors were with shingles outcomes. Forbes, looked at 144,959 cases of shingles in the United Kingdom between 20. Risk factors cited by the authors include lupus, rheumatoid arthritis (RA), chronic obstructive pulmonary disease (COPD), inflammatory bowel disease, asthma, chronic kidney disease, diabetes, and depression. Researchers at the London School of Hygiene and Tropical Medicine reported in a study published in BMJ that patients with autoimmune diseases and other chronic illnesses face an increased risk for herpes zoster, or what is commonly referred to as shingles. In adults who are or will be immunodeficient or immunosuppressed due to known disease or therapy and who would benefit from a shorter vaccination schedule, the second dose may be administered 1 to 2 months after the first dose.
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