Arthritis drug boosts risk of shingles, scientists warn

Patients with rheumatoid arthritis have long been known to be at a higher risk of the skin condition, which is caused by the chicken pox virus, Herpes zoster. Commonly known as shingles, the skin condition produces maddeningly itchy blisters.

Now, German researchers have established a link between shingles and rheumatoid arthritis drugs called anti-TNF-alpha agents. The drugs are artificial antibodies which prevent the immune system signals partially responsible for rheumatoid arthritis.

The German researchers based their findings on analysis of data from 5,000 patients receiving various forms of treatment.

A total of 86 outbreaks of shingles were identified among 82 patients. Thirty-nine occurrences coincided with treatment with the anti-TNF-alpha agents adalimumab and infliximab. Etanercept, a protein therapy, and conventional disease-modifying anti-rheumatic drugs (DMARDs) were associated with 23 and 24 cases respectively.

After adjusting for age, illness severity, and use of steroid hormone therapies, the risk of shingles almost doubled when patients were receiving anti-TNF-alpha agents. However, this was below the statistical threshold defining clinical significance, which was an increased risk of more than double.

The German scientists, led by Dr Anja Strangfeld from the Rheumatism Research Centre in Berlin, wrote in the Journal of the American Medical Association: “Based on our data, we recommend careful monitoring of patients treated with monoclonal anti-TNF-alpha antibodies for early signs and symptoms of Herpes zoster.”

About one in five people have shingles at some time in their life. After a case of chicken pox, the Herpes zoster virus may remain dormant in nerve roots next to the spinal cord. Perhaps many years later, they can become re-activated and travel along the nerve to cause shingles.

It is possible to catch chicken pox from someone with shingles, but shingles itself cannot be passed from person to person.

The infection can occur at any age, but is most common in people over the age of 50 and in those with poor immune systems.

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