Autoimmune disease + shingles = 50% increase in stroke risk

People who have autoimmune diseases, including psoriasis, who get incident herpes zoster have a 50 percent increased stroke risk within a month of developing shingles, according to a new study.

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The frequency of herpes zoster, an opportunistic infection caused by varicella zoster virus, is increasing among patients on immunosuppressive therapies, including biologics.

Researchers from the Cleveland Clinic in Ohio, analyzed Medicare data from 2006 to 2012 to identify nearly 51,000 patients with incident herpes zoster and diagnoses of one of these autoimmune diseases: ankylosing spondylitis, inflammatory bowel disease, psoriasis, psoriatic arthritis or rheumatoid arthritis. They followed patients for ischemic stroke hospitalizations after shingles diagnoses, comparing one-, six- and 12-month follow ups.

Read: Antiviral vaccine rebounds versus herpes

Six months post herpes zoster diagnosis, the crude incidence rate of hospitalized ischemic stroke was 9.8 for each 1,000 patient years, compared to a rate of 8.7 per 1,000 in years two to six, according to the study. Among patients with more complicated herpes zoster, which represented two-thirds of the group, that hazard ratio for stroke was 3.2 in the first 30 days, compared to 1.6 in the uncomplicated group. Patients who were prescribed antivirals with seven days of their herpes zoster diagnoses had a 16 percent lower stroke risk than those who were not on antivirals, according to the study.

The study highlights the need to develop strategies to reduce herpes zoster risk among immunosuppressed patients, according to the authors.

Study author according to Leonard H. Calabrese, D.O., vice chair of rheumatic and immunologic diseases at the Cleveland Clinic, told Dermatology Times the results suggest two things to dermatologists.

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“… one, prompt diagnosis and treatment of zoster is important to potentially reduce stroke risk, and two, for patients with immune mediated dermatologic disorders (such as psoriasis) on immunosuppressive therapy, preventive measures (i.e. vaccination) are of increased importance now viewing the risk of stroke,” according to Dr. Calabrese.

The researchers presented their findings in November 2015 at the 2015 American College of Rheumatology (ACR) and the Association for Rheumatology Health Professional (ARHP) Annual Meeting in San Francisco.