RESEARCH - Rates and predictors of herpes zoster (shingles) in patients with RA and non-inflammatory musculoskeletal disorders

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Rheumatology (Oxford). 2006 Sep 26; [Epub ahead of print]

Rates and predictors of herpes zoster in patients with rheumatoid arthritis

and non-inflammatory musculoskeletal disorders.

National Data Bank for Rheumatic Diseases, Wichita, KS, USA; University of

Kansas School of Medicine, Wichita, KS, USA.

Objectives. Herpes zoster (HZ) is a common disorder that causes substantial

pain and morbidity. We examined its rate and predictors in rheumatoid

arthritis (RA) and non-inflammatory musculoskeletal (MSK) disorders to

determine if HZ was increased in RA and whether treatment contributed to the

risk of HZ. Methods. After excluding patients with prior HZ, we assessed 10

614 RA and 1721 MSK patients by semi-annual questionnaires during 33 825

patient-years of follow-up. Predictors of HZ were determined by

regression and expressed as hazard ratios (HR) and 95% confidence intervals

(CI). Results. The annualized incidence rate per 1000 patient-years was 13.2

(95% CI 11.9-14.5) in RA and 14.6 (95% CI 11.2-18.1) in MSK, and did not

differ significantly after adjustment for age and sex. HZ was predicted by

impaired functional status, as measured by the Health Assessment

Questionnaire (HAQ), [hr 1.3 (95% CI 1.1-1.5)] and by the use of

COX-2-specific non-steroidal anti-inflammatory drugs (NSAIDs) [hr 1.3 (95%

CI 1.1-1.6)] in RA and MSK. In multivariable analyses in patients with RA,

cyclophosphamide HR 4.2 (95%CI 1.6-11.5), azathioprine HR 2.0 (1.2-3.3),

prednisone HR 1.5 (1.2-1.8), leflunomide HR 1.4 (1.1-1.8) and COX-2 NSAIDs

HR 1.3 (95% CI 1.1-1.6) were significant predictors of HZ.

Conclusion. The incidence of HZ is increased in RA and MSK compared with

population-based rates. However, the rate of HZ in RA is not increased

compared with MSK. After adjustment for severity, various treatments, but

not methotrexate or biologics, were risk factors for HZ.

PMID: 17003175

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Retrieve & dopt=Abstra\

ctPlus & list_uids=17003175

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