Increased incidence of shingles in people with lupus

Lupus Foundation of America

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A study published in a recent issue of the journal Lupus reports that people with lupus had a 70 percent increased risk of developing shingles compared to participants without inflammatory disease. Shingles (herpes zoster) is a painful skin rash caused by the varicella zoster virus, the same virus that causes chicken pox. Once someone has chicken pox, the virus remains silently in nerve cells, kept “in check” by the immune system. 

Previous studies have suggested that people with lupus are at increased risk of developing shingles. This increase is likely due to cell-mediated immunity among people with lupus, and/or the immunosuppressive medications they take to control the disease.

In this study, investigators compared the incidence and risk factors for shingles in people with lupus to those of people with non-inflammatory musculoskeletal conditions, which include osteoarthritis and related disorders.

Approximately 98 percent of adults in the United States have the varicella zoster virus and they continue to carry it in dormant form within the nerves. Shingles occurs when the virus “wakes up” due to stress, aging or a weakened immune system.

For this study, investigators used data from semi-annual questionnaires submitted to the National Data Bank for Rheumatic Diseases (NDB) between 2001 and 2009 (the “observation period”).

The investigators examined records of people with lupus, and people with non-inflammatory musculoskeletal disorders, who served as a control group. The investigators excluded people who had developed shingles prior to joining the databank, as well as those diagnosed with fibromyalgia.

Based on the number of new shingles cases reported during the observation period, the investigators determined that people with lupus had a 70 percent increased risk of developing shingles compared to participants without inflammatory disease, even after controlling for age, sex, and disability status. Among those with lupus, the use of prednisone or mycophenolate mofetil created an additional risk of developing shingles. However, there was no observed increased risk conferred by use of other drugs used to help combat lupus, such as cyclophosphamide, azathioprine, methotrexate, or hydroxychloroquine.

Despite having a higher risk for shingles, people with lupus have the lowest shingles vaccination rates among all age-eligible people due to lack of awareness about vaccine availability, cost of vaccination, and lack of safety data among people with lupus. Better understanding of the safety and efficacy of the vaccine may increase vaccination rates and help lessen the risk of shingles among people with lupus.

The safety of the vaccine has not been thoroughly studied in people with lupus, but studies are currently ongoing. However, a live-attenuated vaccine generally has not been recommended for people with compromised immune systems, particularly those receiving immunosuppressive medications. 

While shingles is not contagious, it is possible for a person with shingles to infect another person with the varicella zoster virus if that person never had chicken pox before, thereby causing chicken pox.

Increased incidence of herpes zoster among patients with systemic lupus erythematosus.
Chakravarty E, Michaud K, Katz R, and Wolfe F. (2013).
Lupus 22: 238-244.