Incidence and Time Trends of Herpes Zoster in Rheumatoid Arthritis: A Population‐Based Cohort Study

Abstract

Objective To determine the incidence, time trends, risk factors and severity of herpes zoster (HZ) in a population-based incidence cohort of patients with rheumatoid arthritis (RA) compared to a group of individuals without RA from the same population. Methods All residents of Olmsted County, MN who first fulfilled 1987 American College of Rheumatology criteria for RA between 1/1/1980 and 12/31/2007 and a cohort of similar residents without RA were assembled and followed by retrospective chart review until death, migration, or 12/31/2008. Results There was no difference in the presence of HZ prior to RA incidence/index date between the cohorts (p=0.85). During follow-up 84 patients with RA (rate: 12.1 per 1000 person-years) and 44 subjects without RA (rate: 5.4 per 1000 person-years) developed HZ. Patients with RA were more likely to develop HZ than those without RA (hazard ratio: 2.4; 95% confidence interval: 1.7, 3.5). Patients diagnosed with RA in 1995–2007 had a higher likelihood of developing HZ than those diagnosed in 1980–1994. Erosive disease, previous joint surgery, use of hydroxychloroquine and corticosteroids were significantly associated with the development of HZ in RA, while the use of methotrexate or biologic agents was not. Complications of HZ occurred at a similar rate in both cohorts. Conclusion The incidence of HZ is increased in RA and has risen in recent years. The increasing incidence of HZ in more recent years is also noted in the general population. RA disease severity is associated with development of HZ.

The incidence of herpes zoster in cutaneous lupus erythematosus (CLE), dermatomyositis (DM), pemphigus vulgaris (PV), and bullous pemphigoid (BP)

“…Prior studies found that patients with DM on chloroquine had a 6-fold increased risk of zoster compared with those not on chloroquine, 19 and that the use of hydroxychloroquine in rheumatoid arthritis was associated with a statistically significant increased risk of zoster. 20 Antimalarials may decrease interferon production from peripheral blood mononuclear cells via Toll-like receptors 7 and 9 and consequently depress the immune response to viral infections.…”

Treatment considerations in patients with concomitant viral infection and autoimmune rheumatic diseases

“…The highest incidence is seen among patients with Wegener's granulomatosis and SLE. The incidence of herpes zoster in RA is higher than that in psoriatic arthritis (PsA) and ankylosing spondylitis (AS) [120], and it has been increasing since 1990 [114]. The variation in incidence might be related to the population studied and underlying diseases as well as the use of IMDs in these patients.…”

Targeted Therapy and Infections in Rheumatic Diseases

“…B.М.Veetil и соавт. [112] отметили выра-женную тенденцию к нарастанию частоты HZ-инфекции с течением времени, что совпадает с данными популяцион-ных исследований. Так, риск возникновения герпетической инфекции в когорте пациентов с РА, которым диагноз по-ставлен в период 1995-2007 гг., был значимо выше, чем в когорте 1980-1994 гг.…”