Increased Risk of Herpes Zoster Following Dermatomyositis and Polymyositis

Abstract

This study explored the possible association between dermatomyositis or polymyositis (DM or PM) and the subsequent risk of herpes zoster (HZ).We used data from the Taiwan National Health Insurance (NHI) system to address the research topic. The exposure cohort comprised 2023 patients with new diagnoses of DM or PM. Each patient was frequency matched according to age, sex, index year, and comorbidities including diabetes, renal disease, obesity, malignancy, rheumatoid arthritis, immunodeficiency virus infection, autoimmune disease not elsewhere classified, mixed connective tissue disease, or vasculitis with 4 participants from the general population who did not have a history of HZ (control cohort). Cox proportional hazards regression analysis was conducted to estimate the relationship between DM or PM and the risk of subsequent HZ.The incidence of HZ in the exposure and control cohorts was 35.8 and 7.01 per 1000 person-years, respectively. The exposure cohort had a significantly higher overall risk of subsequent HZ than did the control cohort (adjusted hazard ratio [HR] = 3.90, 95% confidence interval [CI] = 3.18–4.77). The risk of HZ in patients with DM or PM in whichever stratification (including sex, age, and comorbidity) was also higher than that of the control cohort.The findings from this population-based retrospective cohort study suggest that DM or PM is associated with an increased risk of subsequent HZ. A synergistic effect was observed between DM or PM and one of the comorbidities.

Incidence and prevalence of vaccine preventable infections in adult patients with autoimmune inflammatory rheumatic diseases (AIIRD): a systemic literature review informing the 2019 update of the EULAR recommendations for vaccination in adult patients with AIIRD

“…The present review has contributed 29 studies,25–51 among them 2 meta-analyses,52 53 expanding the data on the incidence of HZ in AIIRD (table 3). Eleven studies included a control group 25 28 34 39 40 44–46 49–51. Based on the analysis of 21 studies including 894 891 patients, pooled IR and pooled IRR were calculated for patients with AIIRD in general and for specific disease subtypes (figure 2; s upplementary file table 1).…”

Increased risk of herpes zoster in patients with psoriasis: A population-based retrospective cohort study

“…The medical records of comorbidities such as diabetes mellitus (DM, ICD-9-CM 250); hyperlipidemia (ICD-9-CM 272); hypertension (ICD-9-CM 401–405); heart failure (HF, ICD-9-CM 428); vasculitis (ICD-9-CM 446 and 447.6); diffuse diseases of connective tissue(ICD-9-CM 710), including systemic lupus erythematosus(ICD-9-CM 710.0)[ 12 ], systemic sclerosis(ICD-9-CM 710.1)[ 13 ], sicca syndrome [ 13 ](ICD-9-CM 710.2), dermatomyositis (ICD-9-CM 710.3)[ 7 ], polymyositis (ICD-9-CM 710.4) [ 7 ], specified diffuse diseases of connective tissue (ICD-9-CM 710.8), unspecified diffuse connective tissue disease (ICD-9-CM 710.9)[ 13 ]; renal disease (ICD-9-CM 580–589); cancer (ICD-9-CM 140–208); inflammatory bowel disease (IBD; ICD-9-CM 555 and 556); chronic obstructive pulmonary disease (COPD, ICD-9-CM 491, 492, and 496), and asthma (ICD-9-CM 493) were obtained before the index date. We defined prescriptions of steroid use (including oral steroid and IV steroid) as those being prescribed for continuous 30 days during the period of follow-up.…”

Opportunistic infections in patients with idiopathic inflammatory myopathies

“…It has been proposed that VZV has a special tropism for the activated memory T cells usually found in the characteristic muscle inflammatory infiltrate and this could explain a higher frequency of VZV infection in these patients. Strong immunosuppressive therapy and lymphopenia, also seen in our patients, are the main risk factors for developing these viral infections . Herpes zoster vaccination has proven effective in older individuals, but data are lacking in immunosuppressed patients.…”

“…[10][11][12] Cellular immune dysfunction and imbalances between different interleukins may contribute to explain this finding. It has been proposed that VZV has a special tropism for the activated memory T cells usually found in the characteristic muscle inflammatory infiltrate 20,21 and this could explain a higher frequency of VZV infection in these patients. Strong immunosuppressive therapy and lymphopenia, also seen in our patients, are the main risk factors for developing these viral infections.…”

“…Strong immunosuppressive therapy and lymphopenia, also seen in our patients, are the main risk factors for developing these viral infections. 20,22 Herpes zoster vaccination has proven effective in older individuals, but data are lacking in immunosuppressed patients. In myositis patients receiving immunosuppressive drugs, vaccination should be given on an individualized basis.…”