If you have rheumatoid arthritis or psoriatic arthritis, you probably take medications to help reduce joint inflammation and swelling. But some of these medications may have an unintended side effect: They may increase your risk for shingles.
Steroids and DMARD/biologic combination raised shingles risk
A large study that surveyed Medicare data found that patients with rheumatoid arthritis had significantly increased risk for shingles if they took steroid medications such as prednisone.1 Another study discovered an increase in shingles risk for rheumatoid arthritis patients who took a Janus kinase (JAK) inhibitor known as tofacitinib (Xeljanz).2
For those with psoriatic arthritis, the medications that raised shingles risk were found to be a combination of disease-modifying antirheumatic drugs (DMARDs) and tumor necrosis factor (TNF) inhibitors, such as Humira.3 However, neither one of these medication types raised risk when taken alone—only when combined.
- See also Psoriatic Arthritis Treatment
What is shingles?
Shingles is a condition caused by herpes zoster, the same virus that causes chickenpox. Anyone who's had chickenpox can get shingles—in fact, one-third of adults in the U.S. will get it at some point.
Shingles causes outbreaks that start with painful, itchy, or irritated patches of skin on one side of the face or body. In a few days, a rash develops that blisters and eventually scabs over. A shingles outbreak usually clears up in 2 to 4 weeks, but outbreaks can recur later.
In addition, a serious complication called post-herpetic neuralgia (PHN) can occur after a shingles outbreak. No one knows why or when it will occur, but postherpetic neuralgia causes severe and debilitating pain in the area where the rash was, and can last weeks, months, or even years. Risk for PHN, just like the risk for shingles itself, increases as you age.
Take action to prevent shingles
Luckily, there's an important step you can take to help prevent a shingles outbreak: There's a shingles vaccine, which is approved for adults older than 50. It's also recommended by the American College of Rheumatology for anyone with rheumatoid arthritis. The vaccine has been found to be safe—even for people taking medications that suppress the immune system, such as biological agents.
The vaccine significantly reduces your odds of getting shingles, but doesn't eliminate it altogether. However, even if you have a shingles outbreak after receiving the vaccine, your chances for developing PHN afterward are reduced.
Talk with your doctor about whether the shingles vaccine is right for you.
- "Risks of Herpes Zoster in Patients with Rheumatoid Arthritis According to Biologic Disease Modifying Therapy." Arthritis Care & Research 2014 Sep 8. [Epub ahead of print]
- "Herpes zoster and tofacitinib therapy in patients with rheumatoid arthritis." Arthritis Rheumatol. 2014 Oct;66(10):2675-84.
- "Psoriatic arthritis treatment and the risk of herpes zoster." Ann Rheum Dis. 2014 Sep 26. [Epub ahead of print]