School of Clinical Medicine, University of Cambridge, Cambridge, UK.
Clin Exp Rheumatol. 2012 Nov-Dec;30(6):962-71. Epub 2012 Dec 17.
Methotrexate (MTX) has become the foundation disease-modifying anti-rheumatic drug (DMARD) for RA. However, concern exists regarding its possible association with infectious complications including varicella zoster virus (VZV) and herpes zoster (HZ). Furthermore, no consensus exists regarding pre-MTX VZV screening or the use of VZV vaccine.
We undertook systematic literature review (SLR) investigating the relationship between the use of MTX in patients with RA and VZV and HZ infection. Additionally, the European Centre for Disease Prevention and Control, HPA, the CDC, Rheumatology societies and WHO web sites and publications were consulted.
Thirty-five studies fulfilled the inclusion criteria comprising 29 observational studies and 6 case reports. The case reports and 13 observation studies considered the association between MTX and HZ. Three of the observational studies reported a positive association although in 5 cases, patients were concurrently treated with prednisolone. Five studies concluded that there was no association between HZ and MTX. Three studies comparing the infection rates of MTX with other RA therapies found that MTX did not result in higher HZ infection rates. Three studies examining the association between HZ and MTX treatment duration failed to show a link.
No evidence exists to support an association between MTX and VZV infection in RA patients and the data regarding the role of MTX in HZ development is conflicting. The role of pre-MTX VZV screening is controversial and, as it may delay initiation of RA treatment, we suggest against VZV screening in this context.
甲氨蝶呤（MTX）已成为类风湿关节炎（RA）的基础疾病修饰抗风湿药物（DMARD）。然而，人们担心它可能与包括水痘带状疱疹病毒（VZV）和带状疱疹（HZ）在内的感染并发症有关。此外，关于 MTX 治疗前 VZV 筛查或 VZV 疫苗的使用尚无共识。
我们进行了系统文献回顾（SLR），以调查 RA 患者使用 MTX 与 VZV 和 HZ 感染之间的关系。此外，还查阅了欧洲疾病预防控制中心、英国公共卫生署、美国疾病预防控制中心、风湿病学会和世界卫生组织的网站和出版物。
符合纳入标准的 35 项研究包括 29 项观察性研究和 6 项病例报告。病例报告和 13 项观察性研究考虑了 MTX 与 HZ 之间的关系。其中 3 项观察性研究报告了 MTX 与 HZ 之间存在正相关，尽管在 5 例患者中，患者同时接受了泼尼松龙治疗。5 项研究得出结论，MTX 与 HZ 之间没有关联。三项比较 MTX 与其他 RA 治疗方法的感染率的研究发现，MTX 并未导致 HZ 感染率升高。三项研究检验 HZ 与 MTX 治疗持续时间之间的关系，但未能发现两者之间存在联系。
没有证据表明 MTX 与 RA 患者的 VZV 感染之间存在关联，而关于 MTX 在 HZ 发病中的作用的数据存在争议。MTX 治疗前 VZV 筛查的作用存在争议，并且由于它可能会延迟 RA 治疗的开始，因此我们建议在这种情况下不进行 VZV 筛查。
