Significant Associations of Neurological Complications of Herpes Zoster With Stroke in Rheumatoid Arthritis Patients

Abstract

BackgroundAccumulating evidence suggests an increased risk of stroke after herpes zoster (HZ). This risk is elevated in immunocompromised patients. The incidence of HZ in Asia is higher than in Western countries. However, the epidemiology of HZ and HZ‐related stroke among rheumatoid arthritis (RA) patients in Asia remains unclear.Methods and ResultsWe conducted a retrospective cohort study using a population‐based database to investigate the epidemiology of HZ in RA patients in Taiwan during the period of 2000‐2011. A total of 27 609 newly diagnosed and eligible RA cases were identified, and 110 436 non‐RA cases were matched for age and sex at a ratio of 4:1. HZ risk increased by 2.53‐fold (P<0.0001) in RA patients compared with the general population. Exposure to corticosteroids (adjusted odds ratio=1.73, P<0.0001), adalimumab (adjusted odds ratio=1.61, P=0.002), and rituximab (adjusted odds ratio=2.06, P=0.008) was associated with an increased risk of HZ in RA patients. A significant association between the use of methotrexate or corticosteroids and HZ risk was dose‐dependent (P trend<0.0001). Elevated risk of stroke was observed in RA patients with HZ (adjusted hazard ratio=1.27, P=0.047), particularly in those with neurological complications (adjusted hazard ratio=1.54, P=0.015). A 2.30‐fold significantly increased risk of stroke within 90 days after HZ occurrence was observed in RA patients compared with those without HZ (P=0.02). Furthermore, death risk increased in RA patients with HZ (adjusted hazard ratio=1.18, P=0.026).ConclusionsThe risk of HZ and HZ‐related stroke has increased in RA patients. Monitoring the occurrence of HZ in RA patients and preventing HZ‐related stroke or mortality during a specific immunosuppressive therapy are important.

The risk of herpes zoster among patients with ankylosing spondylitis: A population‐based cohort study in Taiwan

“…It was reported that there was an age‐specific decrease in VZV memory CD4 cells, so immunosenescence may be the key cause which leads to the increase of VZV infection and reactivation in the elderly . Previous studies showed that in Taiwan age is also a major risk factor for HZ . We obtained a similar result.…”

“…25 Previous studies showed that in Taiwan age is also a major risk factor for HZ. 17 We obtained a similar result.…”

“…The reason for regional differences in HZ morbidity are still unclear; this may be because of the ethnic distinction and the cultural differences . Many studies have shown that the incidence of HZ is higher in some autoimmune diseases, for example RA and SLE, but few studies have shown the incidence of HZ in AS patients. In the USA, the incidence rate of HZ in AS patients is higher than in the general population, but the results showed no statistical significance .…”

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).…”

Herpes Zoster in rheumatoid arthritis patients receiving tofacitinib, a single center experience from Taiwan

“…Herpes zoster (HZ) is a prevalent and potentially debilitating illness caused by varicella zoster virus (VZV) reactivation [ 1 ] ; its common complications include post-herpetic neuralgia, ophthalmic involvement, and neurological sequelae. [ 2 , 3 ] Patients with rheumatoid arthritis (RA) have increased risk for HZ, [ 4 , 5 ] and iatrogenic risk factors include glucocorticoids, methotrexate, and biologic agents used to treat RA. [ 6 ] Weakened host cell-mediated immunity is an important etiologic factor for varicella zoster reactivation.…”