LAUSR

Background Immunosuppressed patients such as Rheumatoid Arthritis (RA) patients have a greater risk (1.5-2 times) of presenting herpes zoster (HZ). Both, the disease itself and the use of immunosuppressive drugs, are involve in this increased risk. Furthermore, in these patients is more frequent a disseminated presentation of zoster involving several dermatomes. Objectives In a series of RA patients our aim was analyzed HZ infections and to assess a) HZ prevalence and b) HZ general features Methods Prospective Single center study of 390 RA patients included in the vaccination program of the Preventive and Rheumatology department of our hospital between october 2011 and october 2016. The follow-up was made until December 2017. HZ vaccination is not included in our program. RA was diagnosed according to the ACR/EULAR 2010 proposed criteria (Arthritis Rheum 2010; 62: 2569–2581) The diagnose of HZ was made according to the clinical manifestations and was confirmed by a dermatologist. These manifestations were characteristic skin rash and blisters, paresthesia and local pain, in one (localized) or more dermatomes (generalized) Results We studied 390 patients (307♀/83♂), average age 61.28±12.9 years that were included in the vaccination program and followed-up. HZ infection was observed in 12 of 390 (3.07%) in the follow-up (TABLE). The 12 RA patients (11 women/1 man) with a mean±SD age of 67.5±11.67. More than half of patients, 7 (58.33%) were taking corticosteroids. 8 patients (66.66%) were receiving conventional disease modifying drugs (DMARDs) methotrexate (33.33%), leflunomide (16.66%) and hydroxychloroquine (16.66%). Besides corticosteroids and conventional DMARDs, 7 patients (58.33%) were in treatment with biologic drugs, tocilizumab (n=2), etanercept (n=2), adalimumab (n=2), and rituximab (n=1). Conclusion Herpes zoster is a relative frequent viral infection in RA patients non-vaccine for HZ. The female sex, older age, more aggressive RA and treatment with corticosteroids were more frequent. Probably in this group of patients HZ vaccination may be useful. Case Sex Age (years) Duration of RA (months) RF +/- APCA +/- Erosive RA HZ Localization Previous Herpes Viral serology HZ Treatment Concomitant treatment for RA 1 ♀ 74 339 + + Yes Left arm IgG+ IgM NR Famciclovir Corticoids/MTX/TCZ 2 ♀ 86 142 + - Yes - IgG+ IgM - None (topic) ETN 3 ♀ 80 90 - - Yes Gluteus (right) IgG + IgM NR Brivudina HCQ 4 ♀ 83 313 + - Yes D9-D10 metamer IgG + IgM - Brivudina Corticoids/MTX/RTX 5 ♀ 52 222 + - Yes Generalizated IgG + IgM NR Aciclovir Corticoids 6 ♀ 70 171 + - No Left arm IgG+ IgM NR Aciclovir Corticoids/MTX/ADA 7 ♀ 68 1 + - Yes Intercostal (left) IgG + IgM - Brivudina Corticoids/HCQ 8 ♀ 61 40 - - No - IgG + IgM NR - Corticoids/LFN/TCZ 9 ♂ 58 34 + + No Intercostal (left) IgG + IgM NR Famciclovir None 10 ♀ 62 67 + + Yes Intercostal (left) IgG + IgM NR Aciclovir LFN/ETN 11 ♀ 50 5 - - No Intercostal (left) IgG + IgM NR Aciclovir Corticoids/MTX/ADA 12 ♀ 66 2 + + No Gluteus (left) IgG + IgM - Aciclovir None TABLE General features of 12 RA patients at HZ infection Abbreviatures: MTX: methotrexate, LFN: leflunomide, HCQ: hydroxicloroquine, TCZ: tocilizumbas, ADA: adalimumab, ETN: etanercept Disclosure of Interests: Lucia Domínguez: None declared, Vanesa Calvo-Río: None declared, Paz Rodriguez-Cundin: None declared, Virginia Portilla: None declared, Nuria Vegas-Revenga: None declared, Francisco Manuel Antolin-Juarez: None declared, Maria Henar Rebollo Rodriguez: None declared, Alfonso Corrales: None declared, D. Prieto-Peña: None declared, Monica Calderón-Goercke: None declared, Miguel A González-Gay Grant/research support from: Prof. MA Gonzalez-Gay received grants/research supports from Abbvie, MSD, Jansen and Roche., Speakers bureau: Consultation fees/participation in company sponsored speaker’s bureau from Pfizer, Lilly, Sobi, Celgene, Novartis, Roche and Sanofi., Ricardo Blanco Grant/research support from: Abbvie, MSD, and Roche, Consultant for: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen, Speakers bureau: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen