Herpes zoster flares linked to lupus onset

[Guest guest]

Rheumawire

Feb 11, 2004

Herpes zoster flares linked to lupus onset

London, ON - Patients with systemic lupus erythematosus (SLE) are more

likely than nonlupus patient to have had reactivation of varicella

zoster virus (VZV) as shingles, particularly around the time of SLE

diagnosis, Dr Janet E Pope (University of Western Ontario, London)

reports in the February Journal of Rheumatology [1]. The lupus patients

also had more vaccinations than controls, but Pope speculates that this

might have been because they were somewhat younger.

" I think future studies would be helpful to determine how SLE subjects

clear certain viruses such as the herpes family, " Pope tells rheumawire.

" We know that they have skin test anergy to these viruses (T cells), but

high antibody titers (B cells), so the actual primary problem in SLE

could be due to T cell dysfunction, with secondary B-cell

hyperstimulation, or vice versa. "

Pope's case-control study investigated the prevalence of infections,

antibiotic use, vaccinations, and joint trauma before and at diagnosis

of SLE. The investigators studied 61 SLE patients and 173 control

subjects who had " diagnosis of noninflammatory rheumatic disorder such

as osteoarthritis, tendonitis, or fibromyalgia. " Mean duration of

disease was 8 years for SLE and 10 years for controls. The only

significant difference was that the SLE patients were younger (mean age

49 vs 57 years, p<0.0004). Data were gathered by mailed questionnaire

(response rate 66% for SLE patients, 69% for controls).

Pope found that SLE patients were more likely than controls to have a

history of shingles (19% vs 7%, OR 2.98, p<0.003) but less likely to

have a history of rubella (23% vs 42%, OR 0.43, p<0.03). The VZV

infections were clustered just before or after the time of diagnosis in

the SLE patients but were not clustered in the controls. This was not

due to immunosuppressive therapy, since only 2 of the SLE patients were

taking immunosuppressants or steroids at the time of shingles.

A number of common infections have been suspected of triggering lupus

onset, but Pope found only a nonsignificant trend toward more

respiratory, urinary-tract, ear, and eye infections during the year

before diagnosis in the SLE group (23% vs 9%, p<0.06).

" I would have thought that the rate of infections in SLE for most common

infections would have been higher just prior to diagnosis, as SLE is

precipitated by immune stimulation (which common organisms can give) and

possibly with autoimmunity, " Pope says. The researchers had expected

that the younger age of the SLE patients might contribute to a somewhat

higher rate of common infections due to such factors as having young

children at home. SLE patients were less likely than controls to report

joint trauma but more likely to have been vaccinated since 18 years of

age with any type of vaccine (69% vs 51%, p<0.04). Age is a possible

confounding factor, since more SLE patients were younger and likely to

have had rubella vaccination after that vaccine became available during

the 1960s.

" There are no real conclusions from our study about vaccinations, as the

finding was not powerful and the study was not designed to look at this

question. If vaccinations increase the risk of SLE by immune

stimulation, a study of thousands of vaccinated vs thousands of

unvaccinated would likely have to be designed but is not feasible in

countries where vaccination rates are high. Or, lupus-predisposed mice

could be used and the vaccination vs sham vaccine studied to see whether

SLE rates are different between the 2 groups. However, in my experience,

only rarely will a patient's SLE flare after a vaccination, " Pope says.

Pope cautions that the association with varicella reactivation as

shingles in patients with SLE does not establish causality, which might

go in either direction. Shingles might precipitate SLE, or SLE-related

immune dysfunction might put the patient at risk for varicella

reactivation. Or both might be reflections of an underlying immune

problem. Other researchers have said that the strong association with

herpes zoster infection at or before the time of lupus diagnosis

suggests that lupus should be considered in differential diagnosis when

a patient presents with shingles [2].

Janis

Sources

1. Pope JE, Krizova A, Ouimet JM, Goodwin JL. Close association of

herpes zoster reactivation and systemic lupus erythematosus (SLE)

diagnosis: Case-control study of patients with SLE or noninflammatory

musculoskeletal disorders. J Rheumatol 2004 Feb; 31(2):274-9. .

2. Strom BL, Reidenberg MM, West S, et al. Shingles, allergies, family

medical history, oral contraceptives, and other potential risk factors

for systemic lupus erythematosus. Am J Epidemiol 1994 Oct 1;

140(7):632-42.

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org

[Guest guest]

I have RA and not lupus, but I have often wondered if there was some

relationship between my RA and shingles. My arthritis symptoms started

in January of 20001; in March I had shingles. Then I found out in

January of 2002 that I had breast cancer. I also wonder if that had any

connection to the RA. Sue

On Thursday, February 12, 2004, at 07:09 PM, wrote:

>

> Pope cautions that the association with varicella reactivation as

> shingles in patients with SLE does not establish causality, which might

> go in either direction. Shingles might precipitate SLE, or SLE-related

> immune dysfunction might put the patient at risk for varicella

> reactivation. Or both might be reflections of an underlying immune

> problem. Other researchers have said that the strong association with

> herpes zoster infection at or before the time of lupus diagnosis

> suggests that lupus should be considered in differential diagnosis when

> a patient presents with shingles [2].