A study published in the December issue of Arthritis Care and Research found that RA patient are nearly twice as likely to develop herpes zoster (also known as shingles) as people without RA. This large, dual country population-based study also found that people with RA who take DMARDs or oral corticosteroids seem to be at higher risk than people who take other types of arthritis drugs.
The research supports several other studies that have found similar results, but so far, none of the studies have been able to determine whether the arthritis drugs are the reason for the increased risk of developing shingles or whether people who need to take these drugs have increased disease severity and whether that disease severity is the factor. One theory is that people with RA have a compromised immune system, even without the drugs, so they may be more likely to contract chicken pox or shingles from the varicella-zoster virus. The researchers concluded that more research should be completed to determine whether the risk is associated with RA disease severity or with certain RA medications. They also called for further study of the risk of complications from shingles among RA patients.
So what is Herpes Zoster?
Herpes zoster is also known as shingles and is caused by the varicella-zoster virus, which also causes chicken pox in children and adults. People contract the virus by having direct contact with someone with active virus. It is estimated that more than 90% of adults in the US have had a varicella-zoster virus infection, and are therefore at risk of developing herpes zoster / shingles as adults. After a person gets chicken pox as a child, the virus stays in the body, but goes dormant in the nerve tracts that come from the spine. Many years later it can then reemerge as shingles in adults. The triggers are factors such as aging, stress and an impaired immune system. However, adults who haven't had chicken pox as a child or the varicella-zoster vaccine can also develop chicken pox as adults, which can be very painful and severe. Shingles are more common in adults over 60 years old, in children who had chickenpox before the age of one year, and in individuals whose immune system is weakened. It is a common disorder and the NIH estimates that up to 1 million people develop shingles each year.
According to Medline Plus (Part of the National Library of Medicine), the typical rash consists of red patches of skin with small blisters. The rash often increases over the next 3 to 5 days. Then, the blisters break, forming small ulcers that begin to dry and form crusts. The crusts fall off in 2 to 3 weeks, leaving behind pink healing skin. Shingles rarely reoccur. Lesions typically appear along a single dermatome, meaning the area of skin around that particular spinal nerve and are only on one side of the body. The trunk is most often affected, but lesions can also occur on the neck or face including the mouth or the eye.
Possible Complications of Shingles
When the face is involved, people should be extra careful to seek medical attention, since eye lesions can lead to blindness and facial lesions may cause Ramsay Hunt syndrome (facial paralysis, hearing loss, loss of taste in half of the tongue and skin lesions around the ear and ear canal). Shingles may, on occasion, involve the genitals or upper leg.
Elderly people are at high risk for a complicating condition called post-herpetic neuralgia. It is persistent pain in the area where the shingles occurred. The pain can last from months to years following the initial episode and can be severe enough to be incapacitating. It is estimated that about 50% of people over the age of 60 will develop this complication.
Herpes zoster usually disappears on its own, but people may seek treatment for symptom relief, such as pain medication or corticosteroids to reduce inflammation. There are also antiviral medications that may be prescribed to shorten the course, reduce pain, reduce complications, or protect an immunocompromised individual.
Non-pharmaceutical treatments include cool wet compresses to reduce pain or soothing baths and lotions, such as colloidal oatmeal bath, starch baths, or lotions and calamine lotion to relieve itching and discomfort. Resting in bed until the fever goes down is recommended.
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