Risk of Developing Herpes Zoster Increased in Rheumatoid Arthritis

Herpes Zoster
Herpes Zoster
The use of corticosteroids at doses of ≥5 mg/d was identified as a significant risk factor for herpes zoster development in patients with RA.

Rheumatoid arthritis (RA) is associated with the development of herpes zoster (HZ), and use of corticosteroids is a significant risk factor, according to a large retrospective study published in the International Journal of Rheumatic Diseases.1

Patients with RA have a high risk for infections either because of the disease itself or because of immunosuppressive treatments,2 and HZ is the second most frequent infection that occurs in this population.3 It is unclear whether use of biological disease-modifying antirheumatic drugs increases the risk for HZ, so researchers used a Japanese health insurance database to compare the incidence rates of HZ in patients with and without RA over the course of 3 years. They then evaluated the risk for HZ development with methotrexate, corticosteroids, and biologic use, including tumor necrosis factor inhibitors (TNFis) and non-TNFi users in patients with RA.1

The researchers found that patients in the RA group (n=6712) had a significantly higher incidence rate of developing HZ than those in the non-RA group (n=33,560; 14.2 vs 8.3/1000 patient-years).

The researchers also found that the use of TNFis, non-TNFis, methotrexate, or immunosuppressive disease-modifying antirheumatic drugs did not increase the risk for HZ. However, use of 5 mg/day or more of corticosteroids did significantly increase the risk of developing HZ in patients with RA.

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Among other limitations, 1 was that the researchers could not confirm the HZ cases using medical records, and therefore had to rely on cases that were treated with antivirus drugs at dosages for HZ to exclude false cases.1

“In conclusion, RA was significantly associated with the development of HZ, and rheumatologists should follow patients with RA carefully for the complication irrespective of the types of [disease-modifying antirheumatic drugs] with continuous efforts to decrease the dosage of concomitant corticosteroids,” stated the authors.1


  1. Sakai R , Kasai S , Hirano F , et al. No increased risk of herpes zoster in TNF inhibitor and non‐TNF inhibitor users with rheumatoid arthritis: epidemiological study using the Japanese health insurance database [published online April 17, 2018]. Int J Rheum Dis. doi: 10.1111/1756-185X.13300
  2. Doran MF, Crowson CS, Pond GR, O’Fallon WM, Gabriel SE. Frequency of infection in patients with rheumatoid arthritis compared with controls: a population-based study. Arthritis Rheum. 2002;46:2287-2293.
  3. Widdifield J, Bernatsky S, Paterson JM et al. Serious infections in a population-based cohort of 86,039 seniors with rheumatoid arthritis. Arthritis Care Res (Hoboken). 2003;65:353-361.