Tuesday, February 20, 2024

Is Shingles An Autoimmune Disease

Shingles On Your Face

Shingles: What You Should Know | Johns Hopkins Medicine

Shingles usually occurs on one side of your back or chest, but you can also get a rash on one side of your face.

If the rash is close to or in your ear, it can cause an infection that could lead to:

  • loss of hearing
  • issues with your balance
  • weakness in your facial muscles

Shingles inside your mouth can be very painful. It may be difficult to eat and may affect your sense of taste.

A shingles rash on your scalp can cause sensitivity when you comb or brush your hair. Without treatment, shingles on the scalp can lead to permanent bald patches.

What Is The Outlook For People With Shingles

Shingles usually follows a pattern of development. It typically progresses with the following symptoms:

  • First, you may notice a tingling or burning sensation in your skin.
  • One to 5 days later a rash appears as small red spots.
  • Fluid-filled blisters develop a few days later.
  • After 7 to 10 days, the lesions crust over.
  • The rash disappears over the next 2 to 4 weeks.

In some cases, pain may persist for several months or even years after the rash has disappeared. This complication, known as postherpetic neuralgia , can be severe enough to affect your quality of life.

Certain antiseizure medications can help manage the pain. Gabapentin and pregabalin are two that are commonly used.

Its unlikely to get shingles more than once but its possible. Thats why its recommended to get the shingles vaccine at age 50 and older, even if youve already had the disease. Getting shingles three times is extremely rare.

Stroke And Other Brain Ailments

In addition to shingles’ telltale rash, neurological symptoms develop quickly and can include headaches, vomiting, fever, and confusion. This could be because varicella zoster virus sits on a nerve. “That nerve cell body has an arm that has contact with the skin, but it also has another arm that goes directly to the brain,” explains Dr. Mukerji. “When the virus goes to the brain, it can cause meningitis, encephalitis, or stroke.”

So, while shingles resulting in brain conditions is rare, it can increase your risk for stroke. Case in point: A 2016 review of epidemiological studies published in the Journal of Stroke & Cerebrovascular Diseases found that during the year after a shingles bout, the risk of stroke increased 59%, and this risk was highest among those under 40.

In addition, shingles can also cause swelling in the brain and seizures, both of which can lead to serious and permanent complications.

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Age And Weak Immune System Increase Your Risk Of Getting Shingles

Although anyone who has had chickenpox can get shingles, your risk of developing shingles increases with age. Most people get shingles in their 50s or later in life.

Its rare to get shingles before 40 years of age. Scientists are still studying why this happens. Its likely that your immune system keeps the virus dormant. When the immune system starts to weaken, which may start in your 50s, the virus can wake up.

Age increases your risk of getting shingles

Many people who had chickenpox dont remember having it and are unaware that they can get shingles.

Anyone who has a weakened immune system also has an increased risk of getting shingles. This includes people who have:

  • Some cancers, such as leukemia or lymphoma

  • Human immunodeficiency virus

  • To take medication that suppresses the immune system, such as people living with an organ transplant, severe psoriasis, or advanced psoriatic arthritis

  • To receive certain cancer treatments, such as chemotherapy

Reporting Of Vaccine Adverse Events

Shingles of the Wrist With a Bullous Evolution

Adverse events that occur in a patient following vaccination can be reported to the Vaccine Adverse Events Reporting System . Reporting is encouraged for any clinically significant adverse event even if it is uncertain whether the vaccine caused the event. Information on how to submit a report to VAERS is available at or by telephone at 1-800-822-7967.

* This recommendation became official CDC policy in January 2018.

Zoster vaccine live is no longer available for use in the United States, as of November 18, 2020.

§Grade 3 reactions are defined as reactions related to vaccination severe enough to prevent normal activities.

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Tnf Inhibitors May Increase Risk Of Shingles

RA patients treated with TNF inhibitors may have a higher risk of shingles than patients treated only with traditional, non-biologic disease-modifying anti-rheumatic drugs. These results were published in the Annals of the Rheumatic Diseases.

Shingles occurs when the varizella zoster virusthe virus that causes chickenpoxreactivates and causes a painful rash or blisters. The rash and blisters typically occur in a band on only one side of the body. Anyone who has previously had chickenpox is at risk of shingles. Factors that increase the risk of shingles include older age and a weakened immune system.

People with RA tend to have a higher rate of skin and soft tissue infection than people in the general population. This is likely due to a combination of the RA and the drugs that are used to it.

To evaluate the relationship between TNF inhibitors and skin and soft tissue infections, researchers evaluated 11,881 patients who had been treated with a TNF inhibitor and 3,673 patients treated only with non-biologic disease-modifying anti-rheumatic drugs . The only TNF inhibitors that were available at the time the study was conducted were Enbrel® , Remicade® , and Humira® .

The risk of shingles was evaluated separately from the risk of other skin and soft tissue infections. Serious skin and soft tissue infections were defined as infections that required hospitalization or intravenous antibiotics, or that resulted in death.

Risk Increased By 50% In The First Month

SAN FRANCISCO — Patients with an autoimmune disease, such as rheumatoid arthritis , have a significantly elevated risk for having a stroke within a month of developing herpes zoster, researchers reported here.

After adjustment for multiple potential confounders, the incidence rate ratio for autoimmune disease patients being hospitalized with an ischemic stroke within 30 days after developing herpes zoster reactivation was 1.50 compared with their rate in subsequent years 2 to 6, according to Leonard H. Calabrese, DO, of the Cleveland Clinic, and colleagues.

Action Points

  • Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

The risk of stroke remained high throughout the first year after the shingles episode, with an incidence rate ratio of 1.30 compared with their risk in year 2, he reported in a plenary session at the at the American College of Rheumatology annual meeting.

“These data are important as we now live in an era of increasing concern over herpes zoster,” Calabrese said.

Zoster is associated with significant morbidity even in its less serious forms, and stroke is one of its potential complications.

However, little is known about the risk among patients with autoimmune diseases — who have an elevated risk for both zoster and stroke.

He urged clinicians to advocate for zoster vaccination.

Disclosures

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Shingles Vaccine Reduces Your Risk Of Getting Shingles

While there is no cure for shingles, getting the shingles vaccine can greatly reduce your risk of getting this disease.

Shingles vaccine reduces risk

The CDC recommends the shingles vaccine for healthy adults who are 50 years of age or older.

If you think you may already have shingles, treatment is important. It can reduce your pain and how long the rash lasts.

Find out how dermatologists diagnose and treat this condition at, Shingles: Diagnosis and treatment.

3 Centers for Disease Control and Prevention . Prevent Shingles: Get vaccinated. Page last reviewed July 23, 2018. Last accessed March 28, 2019.

ImageGetty Images

ReferencesCenters for Disease Control and Prevention . Prevent Shingles: Get vaccinated. Page last reviewed July 23, 2018. Last accessed March 28, 2019.

Dooling KL, Guo A, et al. Recommendations of the Advisory Committee on Immunization Practices for Use of Herpes Zoster Vaccines. Morb Mortal Wkly Rep 2018 67:103-8.

Vaccination: Your Better Option

Herpes Zoster and the Risk of Stroke in Patients with Autoimmune Diseases

Compare those complications to the minor side effects that you might experience with the shingles vaccine: pain, swelling, itching at the injection site, and mild flu-like symptoms for only a few days. “The vaccine produces a robust response that really stimulates your immune system,” Dr. Mukerji says. “A lot of people have fatigue, headaches, and generally feel unwell. But those minor reactions are nothing compared to having shingles.”

According to the CDC, everyone over age 50 should get vaccinated against shingles, even if they’ve already had the disease or don’t recall having chickenpox. And since Shingrix is not made from a live virus, it’s even safe for people who have weakened immune systems.

“Shingles can be life-threatening in immune-compromised patients. It can be disabling if it’s located on the wrong nerve. And it’s completely preventable,” says Dr. Ostroksy, who visited the pharmacy on his 50th birthday to get his first dose of the Shingrix vaccine.

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Recurrent Shingles: Herpes Zoster Can Strike More Than Once

Heres what to know about recurrent shingles and risk factors.

Individuals who have experienced the painful and often debilitating condition known as shingles would like to think that its a 1-and-done infection. Unfortunately, although a reoccurrence of shingles is not common, it can and does happen due to the innate nature of the varicella zoster virus that causes the latent infection.

VZV does not discriminate by age. The virus is at the root of both the childhood infection known as chickenpox and the adult infection shingles. Both chickenpox and shingles are characterized by a blistering red rash. Other shared symptoms include fever, fatigue, and headache.

Once the primary infection resolves, VZV moves into the dorsal root ganglia where it remains dormant for decades. It can then reactivate as HZ and possibly cause serious complications like postherpetic neuralgia and postherpetic itch .

According to the CDC, an estimated 1 million cases of HZ occur annually in the United States. Although the incidence rate in the general population is about 4 cases per 1000 individuals, it increases to about 1 case per 100 individuals among people who are 60 years and older.1

Other risk factors include age , gender , high anxiety and stress levels, certain immunosuppressive therapies, cancer, autoimmune diseases like HIV/AIDS and lupus, and chronic diseases like diabetes, hypertension, and chronic obstructive pulmonary disease.1

References

Shingles: A Common And Painful Virus

Date:
Loyola University Health System
Summary:
Shingles is a painful viral infection that affects almost one million people worldwide and 30 percent of Americans every year. Known as herpes zoster, its caused by the same virus that causes chicken pox, the varicella-zoster virus. The outbreak occurs mostly in people older than 50 because the virus can lay dormant in the nerve tissue of the body for many years then become activated and cause shingles later in life. A new article gives advice and guidance for those at risk.

Shingles is a painful viral infection that affects almost one million people worldwide and 30 percent of Americans every year. Known as herpes zoster, it’s caused by the same virus that causes chicken pox, the varicella-zoster virus. The outbreak occurs mostly in people older than 50 because the virus can lay dormant in the nerve tissue of the body for many years then become activated and cause shingles later in life.

There are some conditions which put people more at-risk:

  • Chronic lung or kidney disease
  • History of chicken pox

A shingles outbreak can last several weeks. Even before the rash appears the following symptoms may occur:

Most people with shingles do not suffer any complications. Still, there is a 10 percent chance of developing a painful condition after the rash has resolved known as postherpetic neuralgia. This condition can last from a few months to a year.

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Exclusion From Clinical Trials

People with RA and other autoimmune disorders were excluded from the initial clinical trials for Shingrix.

Additionally, a handful of case reports have indicated that the shingles vaccine may increase the risk of overactive inflammatory responses. This has led some people with RA to worry about the risk of side effects from the shingles vaccine.

However, larger studies indicate that Shingrix is safe and effective for most people with autoimmune disorders. One 2021 study found that Shingrix was effective in preventing both shingles and PHN, even among immunocompromised people and people over 80 years old.

Potential Ra Medication Complications

San Diego Shingles Treatment

Many of the medications that are prescribed to manage RA symptoms work by suppressing inflammation and the immune response. In some cases, immunosuppressants can make vaccines less effective.

If you take immunosuppressive drugs to treat rheumatoid arthritis, heres what you should know about getting Shingrix:

  • People who are taking low-dose immunosuppressive drugs to treat RA or any other condition should usually get Shingrix.
  • If youre about to start taking an immunosuppressant, its best to get the shingles vaccine a few weeks before your first dose, if possible.
  • If youre taking a moderate or high dose of an immunosuppressive medication to manage RA, talk to your healthcare provider about getting Shingrix. They may decide to delay your next dose of the shingles vaccine.

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Where The Fda And Cdc Stand

According to the CDC, people ages 50 and up and immunocompromised adults ages 19 and older should get two doses of Shingrix to prevent shingles, PHN, and other possible complications. Shingrix is effective and safe for most people, including people with autoimmune disorders.

The CDC currently recommends that people with chronic medical conditions, such as RA, get the shingles vaccine. Additional CDC guidelines for people with autoimmune conditions are as follows:

  • Shingrix is usually delivered in two doses, two to six months apart. If you are immunocompromised, your healthcare provider may suggest that you get your second Shingrix dose after just one to two months instead.
  • Its usually best to wait until your symptoms are well-controlled to get Shingrix. If youre currently having a severe RA flare-up, you should typically wait until you feel better to get the shingles vaccine.
  • If youre taking immunosuppressants to manage RA symptoms, talk to your healthcare provider about the vaccine schedule that works best for you.

The Food and Drug Administration approved the use of Shingrix in 2017 for people ages 50 and older. In 2019, the FDA approved Shingrix for immunocompromised adults ages 18 and older. The FDA hasnt yet issued any specific guidelines about Shingrix and RA.

Preliminary Research From Israel Has Indicated That A Small Number Of Patients With Autoimmune Inflammatory Rheumatic Diseases Developed Shingles After Getting The Covid

Learn more about our FREE COVID-19 Patient Support Program for chronic illness patients and their loved ones.

As we continue to learn more about how individuals with inflammatory disease respond to the COVID-19 vaccine, preliminary new research shows that some people with autoimmune inflammatory rheumatic diseases have experienced herpes zoster reactivation also known as shingles after receiving the Pfizer vaccine.

However, its important to note that this research does not prove that the vaccine causes shingles, as the observational study design was not structured to determine a causal relationship.

And experts want to emphasize how important it is for people with inflammatory rheumatic diseases to get vaccinated against COVID-19.

Israeli researchers were monitoring for post-vaccination side effects in a group of 491 patients with autoimmune inflammatory rheumatic diseases and compared them to side effects experienced by 99 healthy control subjects.

Shortly after receiving the vaccine, 1.2 percent of patients with AIIRD developed their first case of shingles compared to none of the controls, per an April 2021 report in the journal Rheumatology.

  • Four of the six affected individuals had rheumatoid arthritis
  • One had Sjögrens syndrome
  • One had undifferentiated connective disease

In five out of the six cases, the AIIRD patients developed shingles shortly after the first vaccine dose . In one case, shingles infection occurred after the second dose.

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Boost Your Immune System To Fend Off Shingles

The Centers for Disease Control and Prevention estimates that nearly 1 in 3 people in the United States will get shingles at some point, and 1 million new cases are diagnosed annually.

Caused by the chickenpox virus, shingles represents a reactivation of the virus, typically affecting patients who have a compromised immune system because of age, disease or other factors, said Alex Akhondi, MD, FACP, associate program director of internal medicine residency at MountainView Hospital.

Shingles causes a painful skin rash and can be accompanied by flu-like symptoms.

What Are The Possible Side Effects Of Shingrix

What You Should Know About Shingles Vaccines | Johns Hopkins Medicine

Studies show that Shingrix is safe. The vaccine helps your body create a strong defense against shingles. As a result, you are likely to have temporary side effects from getting the shots. The side effects might affect your ability to do normal daily activities for 2 to 3 days.

Most people got a sore arm with mild or moderate pain after getting Shingrix, and some also had redness and swelling where they got the shot. Some people felt tired, had muscle pain, a headache, shivering, fever, stomach pain, or nausea. Some people who got Shingrix experienced side effects that prevented them from doing regular activities. Symptoms went away on their own in about 2 to 3 days. Side effects were more common in younger people.

You might have a reaction to the first or second dose of Shingrix, or both doses. If you experience side effects, you may choose to take over-the-counter pain medicine such as ibuprofen or acetaminophen.

Guillain-Barré syndrome , a serious nervous system disorder, has been reported very rarely after Shingrix. There is also a very small increased risk of GBS after having shingles.

If you experience side effects from Shingrix, you should report them to the Vaccine Adverse Event Reporting System . Your doctor might file this report, or you can do it yourself through the VAERS websiteexternal icon, or by calling 1-800-822-7967.

If you have any questions about side effects from Shingrix, talk with your doctor.

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