Rheumatoid Arthritis Drugs Raise Shingles Risk

Older people and those also taking steroids are most vulnerable, study finds

By Amanda Gardner
HealthDay Reporter

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TUESDAY, Feb. 17 (HealthDay News) -- A class of medications used widely to treat rheumatoid arthritis and other autoimmune diseases might increase the risk of shingles, especially among older people and those who are also taking steroids.

But while the findings, appearing in the Feb. 18 issue of the Journal of the American Medical Association, might raise awareness of the potential complication among physicians and patients, some experts say it's unlikely to change how the drugs are used.

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"We've changed people's lives with use of these anti-tumor necrosis factor drugs. People who were housebound are now leading relatively normal lives," said Dr. Guy Fiocco, an assistant professor of internal medicine at Texas A&M Health Science Center College of Medicine and director of rheumatology at Scott & White in Temple. "This modest increase in risk is not going to stop us prescribing the drug. It may make us more aware."

The increased risk did not reach clinical significance, and, Fiocco added, rheumatoid arthritis itself probably increases the risk of shingles (herpes zoster), as do steroids, which are taken by many people with the disease.

Although the link between TNF blockers and fungal and bacterial infections is fairly well-established, associations with viral infections are less clear.

There have, however, been reports of severe herpes zoster in people taking TNF blockers.

TNF blockers, which suppress the immune system, are used for a variety of autoimmune disorders, including Crohn's disease and psoriasis. In September, the U.S. Food and Drug Administration asked the manufacturers of Humira, Cimzia, Enbrel and Remicade to bolster safety warnings on the risk of developing opportunistic fungal infections. The drugs already carried black-box warnings related to different safety issues. This followed an announcement by the FDA that it would begin a safety review of the drugs, spurred by concerns that the drugs might be associated with cancer.

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