What You Need to Know to Protect Yourself From the Painful Flare-Up

Studies have shown that people with arthritis who take medications that block inflammatory processes have an increased risk of developing shingles. A recent study, published in The Journal of the American Medical Association (JAMA), suggests that patients treated with tumor necrosis factor (TNF) blockers — such as Cimzia, Enbrel, Humira, Remicade and Simponi — have a greater chance of developing the shingles virus. That risk is even greater once patient has been on a TNF blocker for at least one year.

What is Shingles?

Shingles is also known as herpes zoster and it is caused by the varicella-zoster virus, the same virus that causes chicken pox. Once a person recovers from having chicken pox, a small amount of the varicella-zoster virus remains in the nervous system. The virus stays dormant because our immune systems protect us from it.

Older adults are often diagnosed with shingles when the virus reactivates and spreads to nerves and the skin. Unfortunately, the majority of adults do not know about the risk factors for shingles or even what the symptoms are until it is too late, this according to a study out of the University of Texas’ Health Science Center.

Risk factors: Arthritis patients over the age of 50 have a higher chance of developing the virus than do younger people, as reported by the Centers for Disease Control and Prevention. And people of all ages who have compromised and/or suppressed immune systems are susceptible. The use of immunosuppressive medications, such as chemotherapy medications, steroids, and transplant medications, are often to blame for the increased risk. People under prolonged stress are similarly at risk for developing shingles.

You can only get shingles if you had chicken pox and the virus becomes reactivated. Only about 10 to 20 percent of people who have had chicken pox actually develop the shingles virus.

Symptoms: Symptoms of a shingles outbreak can last up to a month. The first indication that something is wrong is merely a tingling feeling in the affected area. This is usually followed by pain and rashes. The most common areas affected by shingles rashes are the chest and abdomen but shingles can affected any part of the body, including the arms, legs, back and the face and eyes.

Pain in the affected area is usually continuous and occurs at least two to three days before a rash develops. Pain can be dull, stabbing and/or burning. Rashes start off as red blotches on the skin and rapidly become blisters, similar to those seen in chicken pox. The blisters last for about a week and then dry out, possibly leaving some scarring of the skin. Some patients experience severe nerve pain because nerves become damaged and pain can go on for months and even years after the shingles symptoms have disappeared. Other symptoms, which are generally mild, include fever, fatigue, headache, upset stomach and confusion and memory issues.

Treatment: There is no cure for shingles, but doctors can treat the symptoms. Rashes should be kept dry and clean to reduce the risk of infection. Pain is treated with over-the-counter pain medications and doctors can prescribe stronger pain medications if pain is severe. Sometimes anticonvulsants such as Gabapentin are prescribed to help control and manage nerve pain. Last, antivirals can stop the shingles virus from reproducing even though they do not necessarily kill the virus.

The JAMA Study

The Journal of the American Medical Association (JAMA) study looked at patients treating with a biologic or other immunosuppressive drug over a three year period. The study participants included 5,040 patients using TNF blockers. Among that group, 82 cases of shingles were reported. Their risk was similar to what was seen in the general population over age 82 but most of the study participants were in their early 50s.

Rheumatoid arthritis patients taking Remicade and Humira had a greater incidence of developing shingles. The risk for these participants was almost double compared to patients not taking TNF blockers. Moreover, the cases of shingles that were observed were far worse than what is seen in the general population, with 20 percent being classified as severe and 13 percent requiring hospitalization.

What You Can Do

Arthritis patients over the age of 50 taking TNF blockers should discuss with their medical provider whether they should receive the shingles vaccine prior to starting their treatment. The vaccine should be administrated at least one month prior to starting a TNF blocker.

Patients who have not taken the shingles vaccine should be particularly alert to the symptoms of shingles. If you suspect you may have shingles, talk to your doctor right away so that an antiviral medication can be administered. This can help keep shingles from causing further damage especially to the face and eyes. Monitor all affected areas for any signs of infection, such as warmth, redness and tenderness. Contact your doctor immediately so that he or she can prescribe an antibiotic.