Herpes Zoster in Rheumatoid Arthritis. Prospective Single Center Study of 390 RA Patients for 5 YEARS

Lucia C. Domínguez-Casas¹, Vanesa Calvo-Río², Paz Rodríguez-Cundín³, Virginia Portilla⁴, Nuria Vegas-Revenga², F. Antolin⁵, M. Rebollo-Rodrigo³, Alfonso Corrales¹, Diana Prieto Peña², Monica Calderón Goercke², Miguel Angel González-Gay⁶ and Ricardo Blanco¹, ¹Rheumatology, Hospital Universitario Marqués de Valdecilla. IDIVAL. Santander. Universidad de Cantabria. Spain, Santander, Spain, ²Rheumatology, Rheumatology. Hospital Universitario Marqués de Valdecilla. IDIVAL. Santander. Universidad de Cantabria. Spain, Santander, Spain, ³Preventive Medicine, Preventive Medicine. Hospital Universitario Marqués de Valdecilla. IDIVAL. Santander. Universidad de Cantabria. Spain., Santander, Spain, ⁴Hospital Universitario Marqués de Valdecilla. IDIVAL. Santander. Universidad de Cantabria. Spain, Santander, Spain, ⁵Preventive Medicine. Hospital Universitario Marqués de Valdecilla. IDIVAL. Santander. Universidad de Cantabria. Spain., Santander, Spain, ⁶Rheumatology. Hospital Universitario Marqués de Valdecilla. IDIVAL. Santander. Universidad de Cantabria. Spain, Santander, Spain

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: Animal models, infection and rheumatoid arthritis

Session Information

Date: Tuesday, October 23, 2018

Title: Rheumatoid Arthritis – Diagnosis, Manifestations, and Outcomes Poster III: Complications of Therapy, Outcomes, and Measures

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose:

Immunosuppressed patients such as Rheumatoid Arthritis (RA) patients have a greater risk (1.5-2 times) of presenting herpes zoster (HZ). Both, the disease itself and the use of immunosuppressive drugs, are involve in this increased risk. Furthermore, in these patients is more frequent a disseminated presentation of zoster involving several dermatomes.

In a series of RA patients our aim was analyzed HZ infections and to assess a) HZ prevalence and b) HZ general features.

Methods:

Prospective Single center study of 390 RA patients included in the vaccination program of the Preventive and Rheumatology department of our hospital between october 2011 and october 2016. The follow-up was made until December 2017. HZ vaccination is not included in our program.

RA was diagnosed according to the ACR/EULAR 2010 proposed criteria (Arthritis Rheum 2010; 62: 2569–2581)

The diagnose of HZ was made according to the clinical manifestations and was confirmed by a dermatologist. These manifestations were characteristic skin rash and blisters, paresthesia and local pain, in one (localized) or more dermatomes (generalized)

Results:

We studied 390 patients (307♀/83 ♂), average age 61.28±12.9 years that were included in the vaccination program and followed-up.

HZ infection was observed in 12 of 390 (3.07%) in the follow-up (TABLE).

The 12 RA patients (11 women/1 man) with a mean±SD age of 67.5±11.67. More than half of patients, 7 (58.33%) were taking corticosteroids. 8 patients (66.66%) were receiving conventional disease modifying drugs (DMARDs) methotrexate (33.33%), leflunomide (16.66%) and hydroxychloroquine (16.66%). Besides corticosteroids and conventional DMARDs, 7 patients (58.33%) were in treatment with biologic drugs, tocilizumab (n=2), etanercept (n=2), adalimumab (n=2), and rituximab (n=1).

Conclusion:

Herpes zoster is a relative frequent viral infection in RA patients non-vaccine for HZ. The female sex, older age, more aggressive RA and treatment with corticosteroids were more frequent. Probably in this group of patients HZ vaccination may be useful.

TABLE General features of 12 RA patients at HZ infection

Case	Sex	Age (years)	Duration of RA (months)	RF +/-	APCA +/-	Erosive RA	HZ Localization	Previous Herpes Viral serology	HZ Treatment	Concomitant treatment for RA
1	♀	74	339	+	+	Yes	Left arm	IgG+ IgM NR	Famciclovir	Corticoids/MTX/TCZ
2	♀	86	142	+	–	Yes	–	IgG+ IgM –	None (topic)	ETN
3	♀	80	90	–	–	Yes	Gluteus (right)	IgG + IgM NR	Brivudina	HCQ
4	♀	83	313	+	–	Yes	D9-D10 metamer	IgG + IgM –	Brivudina	Corticoids/MTX/RTX
5	♀	52	222	+	–	Yes	Generalizated	IgG + IgM NR	Aciclovir	Corticoids
6	♀	70	171	+	–	No	Left arm	IgG+ IgM NR	Aciclovir	Corticoids/MTX/ADA
7	♀	68	1	+	–	Yes	Intercostal (left)	IgG + IgM –	Brivudina	Corticoids/HCQ
8	♀	61	40	–	–	No	–	IgG + IgM NR	–	Corticoids/LFN/TCZ
9	♂	58	34	+	+	No	Intercostal (left)	IgG + IgM NR	Famciclovir	None
10	♀	62	67	+	+	Yes	Intercostal (left)	IgG + IgM NR	Aciclovir	LFN/ETN
11	♀	50	5	–	–	No	Intercostal (left)	IgG + IgM NR	Aciclovir	Corticoids/MTX/ADA
12	♀	66	2	+	+	No	Gluteus (left)	IgG + IgM –	Aciclovir	None

Abbreviatures: MTX: methotrexate, LFN: leflunomide, HCQ: hydroxicloroquine, TCZ: tocilizumbas, ADA: adalimumab, ETN: etanercept

Disclosure: L. C. Domínguez-Casas, None; V. Calvo-Río, None; P. Rodríguez-Cundín, None; V. Portilla, None; N. Vegas-Revenga, None; F. Antolin, None; M. Rebollo-Rodrigo, None; A. Corrales, None; D. Prieto Peña, None; M. Calderón Goercke, None; M. A. González-Gay, None; R. Blanco, None.

To cite this abstract in AMA style:

Domínguez-Casas LC, Calvo-Río V, Rodríguez-Cundín P, Portilla V, Vegas-Revenga N, Antolin F, Rebollo-Rodrigo M, Corrales A, Prieto Peña D, Calderón Goercke M, González-Gay MA, Blanco R. Herpes Zoster in Rheumatoid Arthritis. Prospective Single Center Study of 390 RA Patients for 5 YEARS [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/herpes-zoster-in-rheumatoid-arthritis-prospective-single-center-study-of-390-ra-patients-for-5-years/. Accessed .

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