From the Guidelines
Rheumatoid arthritis (RA) medications, particularly biologic agents like TNF inhibitors and JAK inhibitors (such as tofacitinib), are associated with an increased risk of Herpes Zoster (shingles) and hypercholesterolemia (high cholesterol) due to their immunosuppressive effects and impact on lipid metabolism 1. These medications work by suppressing parts of the immune system that cause joint inflammation, but this also reduces the body's ability to keep the dormant varicella-zoster virus in check.
- The use of tofacitinib, a JAK inhibitor, has been shown to increase the risk of serious infections, including herpes zoster, and has a numerical increase in serious infection rates compared to controls 1.
- Additionally, corticosteroids like prednisone, commonly used for RA, can elevate cholesterol levels, particularly LDL ("bad") cholesterol, while potentially decreasing HDL ("good") cholesterol.
- Patients taking these medications should consider shingles vaccination (Shingrix is preferred, as it's a non-live vaccine safe for immunocompromised individuals) and regular cholesterol monitoring 1.
- Lifestyle modifications including a heart-healthy diet, regular exercise, and possibly cholesterol-lowering medications may be necessary to manage lipid levels while on these RA treatments.
- The 2015 American College of Rheumatology (ACR) recommendations update regarding the use of vaccines in patients with rheumatoid arthritis (RA) starting or currently receiving disease-modifying antirheumatic drugs (DMARDs) or biologics, conditionally recommend giving the herpes zoster vaccine before the patient receives biologic therapy or tofacitinib for their RA in both early or established RA patients ages ≥50 years 1.
From the Research
Rheumatoid Arthritis Medication Associated with Increased Risk
- The medication associated with an increased risk of Herpes Zoster (shingles) and hypercholesterolemia (high cholesterol) in Rheumatoid Arthritis (RA) patients is not directly stated in the provided studies 2, 3, 4, 5, 6.
Related Information
- Methotrexate is considered the preferred disease-modifying anti-rheumatic drug (DMARD) for the treatment of rheumatoid arthritis 2.
- Combination therapy with methotrexate and other DMARDs, such as sulfasalazine and hydroxychloroquine, is effective in controlling disease activity and generally well-tolerated in methotrexate-naïve patients or after an inadequate response to methotrexate 2, 3, 5.
- Corticosteroids may be used to treat acute symptoms and complications of herpes zoster, but their effectiveness is uncertain and they may confer a slight benefit for initial symptoms 4.
- Treatment guidelines for rheumatoid arthritis recommend starting effective treatment immediately with DMARDs, using effective doses of methotrexate, and rapidly escalating treatment with various DMARDs if methotrexate alone is not effective 6.