Rheumatoid Arthritis Raises Shingles Risk

People withrheumatoid arthritis (RA)have roughly twice the risk of healthy older adults of developing shingles, a virus related to chickenpox that causes pain and a blistering rash.

Most adults have been exposed to varicella zoster virus, which causes chickenpox. This virus is never completely cleared from our bodies, but lies quietly in spinal nerve cells. If it’s reactivated it causes shingles, explains rheumatologist Jeffrey Curtis, MD, professor medicine at the University of Alabama at Birmingham. The reactivated virus is called herpes zoster or shingles.

带状疱疹通常开始时在身体一侧的有限区域有灼烧感、刺痛或瘙痒感。几天或几周后，会出现充满液体的水泡，通常是一条带状的水泡缠绕在躯干上，不过带状疱疹也会影响面部和眼睛。疼痛可能相对轻微，主要表现为瘙痒，也可能相当强烈，甚至轻微的触摸都难以忍受。

柯蒂斯博士说:“随着年龄的增长，我们的免疫系统不能有效地保护我们免受感染，这使得带状疱疹病毒更容易‘逃逸’并重新激活。”他指出，带状疱疹在60岁以上的人群中最常见。“如果你患有风湿性关节炎，你的免疫系统已经紊乱，然后，如果你服用的药物进一步削弱了你的免疫防御，病毒更有可能重新激活。”

RA Medications and Shingles Risk

Manymedications for RAsuppress the immune system and can increase the risk of developing shingles. The clearest association is found withcorticosteroids, says Kevin Winthrop, MD, MPH, associate professor of infectious diseases at Oregon Health & Sciences University in Portland.

“Almost every study shows that using prednisone at dosages commonly prescribed for RA [10 mg/day] doubles the risk of developing shingles,” says Dr. Winthrop. “Evidence for other drugs is more mixed.”

A 2015 study published inArthritis Care & Researchused a registry of 28,852 people with RA to look at shingles risk with various drugs, including corticosteroids, conventionaldisease-modifying anti-rheumatic drugs (DMARDS)andbiologics. Results showed only corticosteroid use and aging were linked to an increased risk of shingles.

Dr. Winthrop notes that other studies, particularly those involving tumor necrosis factor (TNF) inhibitors, have found a higher risk of shingles among those taking the medications. Indeed, a 2017 study published inJournal of Rheumatologyfound that TNF inhibitor use and higher corticosteroids doses were significantly associated with shingles in Japanese patients with RA.

Janus激酶抑制剂或JAK抑制剂是治疗RA的最新药物。“JAK抑制剂具有类似生物的特性，但不是生物制剂。虽然它们通常具有类似于生物制剂的安全性，但一个独特的副作用是它们出现带状疱疹的风险增加了一倍，”柯蒂斯博士说。

Shingles Treatment

Prompt treatment with antiviral drugs usually resolves pain and rash in a few weeks. Having RA does not appear to increase the virus’ severity — or its complications, says Leonard Calabrese, DO, professor of medicine and vice chair of Rheumatic and Immunologic Diseases at the Cleveland Clinic in Ohio.

“The most important thing for people with shingles is to get treated quickly,” he says. “Extremely prompt treatment [within three days] can decrease severity as well as forestall complications.”

Shingles Complications

The most common – and feared – complication of shingles is a chronic pain condition called postherpetic neuralgia (PHN), which develops in about 10% to 15% of people who have had shingles.

“这种疼痛可能非常严重，或者主要是皮肤上不愉快的灼烧感或刺痛感。PHN通常会逐渐好转，但有时会持续数年，”卡拉布雷斯博士说。

Other potential complications include inflammation of the eye or retina that can cause pain and vision loss, and ear inflammation that can lead to facial weakness on the affected side.

An increased risk of stroke — which is already elevated in people with RA — is another possible complication of shingles. A 2014 study published inClinical Infectious Diseases, found stroke rates in the month after shingles infection were 1.63 times higher than at other time points.

This risk decreased over following weeks, but remained elevated for about six months. People whose shingles affected their eyes had a three-fold increase in stroke risk 5–12 weeks after their shingles outbreak. Treatment with antiviral medications, however, lowered the risk.

Shingles Prevention

The best way to prevent shingles is to get vaccinated against the virus withZostavax. The “live” vaccine (meaning it contains living though weakened virus) is approved for people older than 50, but the Centers for Disease Control and Prevention advises against using live vaccines, including for shingles, in people taking biologics.

Author: Emily Delzell for the Arthritis Foundation

Related Resources:

• Corticosteroid Use in Rheumatoid Arthritis
• Arthritis Comorbidities
• More Than Just Joints: How Rheumatoid Arthritis Affects the Rest of the Body
• RA with a Side of Fibromyalgia