Shingles More Likely With Some RD Drugs
Some drugs that treat rheumatoid disease may increase your risk for herpes zoster (shingles).
What is shingles?
That’s a sobering thought. Shingles (herpes zoster) is the hibernating virus left in our bodies by the highly contagious herpes varicella virus—the one that causes chicken pox. According to the Centers for Disease Control and Prevention, one in three people will develop shingles in their lifetime.
In those unlucky people, the virus just bides its time, usually sleeping until they’re 60 years old or older before waking up to raise havoc. The virus causes an exquisitely painful, sensitive, burning rash that appears most often in a narrow band on the right side of the body, but may also erupt on the right shoulder, neck, face, or scalp. If the rash spreads into the eye, there’s a serious risk of vision loss.
In some people, shingles causes painful nerve damage where the rash appeared. Called post-herpetic neuralgia, the damage can last anywhere from a few weeks to a lifetime.
People who get shingles are contagious, but not to others who've had chicken pox. They're immune. Instead, those with shingles can infect unvaccinated children and adults who didn't get the virus as kids with herpes varicella--the chicken pox.
Shingles and RA: What's the deal?
And by the way, those of us with rheumatoid disease are already twice as likely to get shingles than people who don’t because of the autoimmune inflammation RD causes throughout the body.
Yuck! Now, About Those RD Drugs …
A study done by researchers in Japan showed that RD patients who take tumor necrosis inhibitors or high-dose steroids are significantly more likely to get shingles than RD patients who don’t.
TNFi’s include such bDMARDs (biologic Disease Modifying Anti-Rheumatic Drugs) as infliximab (Remicade), adalimumab (Humira), etanercept (Enbrel), certolizumab pegol (Cimzia), and golimumab (Simponi). Many RD patients start bDMARDs with one or more of the TNFi’s.
According to an article posted on the Rheumatology Network website, the study’s researchers in Tokyo noted that while TNFi’s are “indispensable in treating patients with rheumatoid arthritis,” their use compromises the immune system and puts patients at an increased risk of infections. “The most common types seen in these patients are skin and soft tissue infections; more than half are herpes zoster outbreaks,” stated the article.
Using a prospective cohort design that looked at 1,987 Japanese patients with rheumatoid disease over five years, the study’s authors “examined the association between development of herpes zoster and the use of bDMARDs, methotrexate, and corticosteroids.”
What They Found
Forty-three of the 1,987 RD patients developed herpes zoster and were treated with one of several antiviral medications. Disseminated herpes zoster developed in five patients and post-herpetic neuralgia in 12 patients.
The study showed that TNFi use was “significantly associated with the development of herpes zoster in patients with rheumatoid arthritis.” In addition, “herpes outbreaks were significantly associated with oral corticosteroid dosage per 1-mg increment by equivalent dosage of prednisolone.”
The study’s authors suggested that physicians monitor their RA patients who take TNFi biologics or high-dose corticosteroids closely for shingles outbreaks. The virus, which is already bad enough, can spread to immunocompromised patients’ organs.
The article reminds readers that “The American College of Rheumatology recommends that patients with rheumatoid arthritis who are 50 years or older receive the herpes zoster vaccine before starting biological disease-modifying anti-rheumatic drugs.”
And I’d like to remind you that some traditional DMARDs, such as leflunomide (Arava), may also compromise your immune system. Always talk with your rheumatologist before taking the herpes zoster vaccine. If you think you’ve developed shingles, get in touch with your rheumatologist or primary provider as soon as you can.
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