RESEARCH - Herpes zoster in patients with RA treated with weekly, low-dose MTX

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Am J Med. 1991 Mar;90(3):295-8.

Herpes zoster in patients with rheumatoid arthritis treated with weekly,

low-dose methotrexate.

Antonelli MA, Moreland LW, Brick JE.

Section of Rheumatology, West Virginia University School of Medicine,

town 26506.

PURPOSE: Herpes zoster occurred in nine patients with

methotrexate-treated rheumatoid arthritis. We compared these patients to

a large group of methotrexate-treated rheumatoid arthritis patients in

order to uncover potential factors explaining the occurrence of herpes

zoster. PATIENTS AND METHODS: Data from 187 patients taking methotrexate

were reviewed and compared with data from another nine patients who

developed herpes zoster while taking the drug for rheumatoid arthritis,

all from the same university-based arthritis clinic. Literature

pertinent to infection in rheumatoid arthritis patients treated with

methotrexate is reviewed. RESULTS: Herpes zoster occurred in 14.5 cases

per 1,000 patient-years in our methotrexate-treated rheumatoid arthritis

patients, as compared with the general population incidence of 1.3 to

4.8 cases per 1,000 patient-years. The infection was unrelated to

duration of methotrexate usage, prednisone treatment, or the

co-existence of diabetes mellitus, but appeared to occur in patients

with high titers of rheumatoid factor and an overall longer duration of

rheumatoid arthritis. There were no cases of systemic dissemination or

recurrence of herpes zoster despite 27.4 years cumulative follow-up on

continued methotrexate therapy.

CONCLUSIONS: Herpes zoster may occur more frequently in patients with

rheumatoid arthritis treated with low-dose methotrexate than in the

general population. Herpes zoster in rheumatoid arthritis patients

treated with methotrexate appears to be self-limited, benign, and

statistically related to methotrexate use in the presence of longer-term

rheumatoid disease.

PMID: 2003511

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=2\

003511 & dopt=Abstract

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