Background/Purpose: Increasing data has suggested that individuals with systemic lupus (SLE) are at increased risk of herpes zoster (HZ) reactivation compared to healthy controls and patients with rheumatoid arthritis, although the immunological basis of increased risk remains unknown.  Primary Sjogren’s syndrome (PSS) shares several immunologic abberations with SLE, but disease manifestations are often less severe and are less likely to be treated with immunosuppression: risks of HZ in this population has remained unstudied.

Methods: We mailed a single-page self-completing questionnaire to participants of 3 established Oklahoma Cohorts: the Oklahoma Lupus Cohort, the Sjogren’s Research Cohort, and the Oklahoma Community Engagement Cohort (individuals without autoimmune diseases recruited to serve as control subjects).  Questionnaires covered questions about recall of chicken pox infection, HZ reactivation, complications, and therapy, as well as receipt of the Zostavax vaccine.  Stored blood samples from respondents were analyzed for cytokines using the xMAP bead assays for 12 cytokines from eBiosciences using a Bio-Rad Bioplex 200 system and BLyS levels were assessed by ELISA to identify cytokines that may be associated with HZ susceptibility.

Results: Completed questionnaires were returned from 635 participants:  350 healthy controls (HC), 163 with PSS and 122 with SLE. The mean age of respondents was 53 years, and the majority were Caucasian women.  Fewer than 20% of HC reported HZ reactivation, compared to 30.7% of PSS and 36.4% of SLE subjects.  The mean age at development of first HZ episode was 10 years younger for SLE than for PSS or HC (39 vs 49 years, p<0.001).  Although many cytokine concentrations were higher in SLE than PSS or HC, these differences were not statistically significant (Table 1).  Multivariate logistic regression found the Odds Ratio for HZ was 1.03 (95% CI 1.02-1.05) for each year of age, 1.8 (95% CI1.2-2.8) for PSS, and 2.7 (1.7-4.3) for SLE.  Ro positivity, but not age, was associated with HZ in SLE patients; both age and anti-Ro status were relevant in pSS.  Among SLE patients, Ro positivity was predictive of earlier age of HZ; this was not seen for pSS. Tested cytokines were not associated with development of HZ.

Conclusion: Subjects with PSS have increased rates of HZ compared to healthy individuals, although less so and at older ages than SLE patients.  Ro seropositivity, but not cytokines, was associated with development of HZ in both SLE and pSS.

Table 1:  Characteristics and cytokine levels of Respondents by Disease Group

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/varicella-zoster-reactivation-in-patients-with-primary-sjogrens-syndrome-and-sle/