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Rising herpes zoster incidence greater among RA patients than general population
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Patients with rheumatoid arthritis had an increased incidence of herpes zoster compared with matched individuals without rheumatoid arthritis, according to study results.
Researchers conducted a population-based study of 813 patients (median age, 55.3 years; 68% women) who were diagnosed with rheumatoid arthritis (RA) between 1980 and 2007 in Olmsted County, Minn., and an age- and gender-matched cohort of 813 residents without RA. All patients were followed longitudinally by a retrospective chart review until death, migration from Olmsted County or the end of 2008.
Cynthia Crowson
Before RA incidence date, there was no difference herpes zoster (HZ) incidence between groups (P=.085). Eighty-four patients with RA (12.1 per 1,000 person-years) and 44 members of the non-RA cohort (5.4 per 1,000 person-years) developed HZ during follow-up. Cumulative incidence of HZ showed that patients with RA were more likely to develop HZ than non-RA patients (HR=2.4; 95% CI, 1.7-3.5). Patients diagnosed with RA from 1995 to 2007 were more likely to develop HZ than patients diagnosed from 1980 to 1994 (HR=1.9; 95% CI, 1.1-3.2).
HZ development in RA patients was significantly associated with erosive disease, previous joint surgery, and the use of hydroxychloroquine and corticosteroids, but not methotrexate or biologics.
“One of the most surprising findings was the association of hydroxychloroquine with herpes zoster in people with RA,” researcher Cynthia Crowson, MS, biostatistician at Mayo Clinic in Rochester, Minn., told Healio.com. “[This suggests] the need for reconsideration of the immunosuppressive effects of hydroxychloroquine.”
Among HZ complications, which were similar between groups, multidermatomal skin involvement occurred in 20% of patients with RA and 16% of those without RA (P=.69).
“Herpes zoster is occurring more frequently in the general population,” Crowson said. “People with RA have also seen increases in the occurrence of herpes zoster … [and] have double the risk of herpes zoster compared to people in the general public.
“Our findings highlight the need for increased awareness of the risk of herpes zoster in people with RA, especially those with severe RA disease, and suggest that a thorough review of existing risk factors, risk modification with vaccination, if possible, and judicious use of immunosuppressive medications may be beneficial.”
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