Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Rheumatology, São Paulo/SP, Brazil.
Clinics (Sao Paulo). 2013 May;68(5):621-7. doi: 10.6061/clinics/2013(05)07.
Herpes zoster has been widely described in the context of different systemic autoimmune diseases but not dermatomyositis/polymyositis. Therefore, we analyzed the prevalence, risk factors and herpes zoster outcomes in this population.
A retrospective cohort study of herpes zoster infections in dermatomyositis/polymyositis patients was performed. The patients were followed at a tertiary center from 1991 to 2012. For the control group, each patient with herpes zoster was paired with two patients without herpes zoster. Patients were matched by gender and the type of myositis, age at myositis onset and disease duration.
Of 230 patients, 24 (10.4%) had a histories of herpes zoster (19 with dermatomyositis and five with polymyositis, two-thirds female). The mean age of the patients with herpes zoster was 44.6±16.8 years. No difference between the groups was found regarding cumulative clinical manifestations. Disease activity, autoantibody, muscle and leukogram parameters were also comparable between the groups. No differences in immunosuppressive (alone or in association with other immunosuppressive therapies) or glucocorticoid (current use, medium dose and cumulative dose in the last two months) therapies were found between patients with and without herpes zoster. However, a higher proportion of patients in the herpes zoster group received chloroquine diphosphate compared to the control group. All of the patients received acyclovir; 58.3% of patients had postherpetic neuralgia and no cases of recurrence were reported. Furthermore, individuals who were taking high prednisone doses at the time of the herpes zoster diagnosis had reduced levels of postherpetic neuralgia.
These data suggest that chloroquine diphosphate could predispose patients with dermatomyositis/polymyositis to developing herpes zoster, particularly women and dermatomyositis patients.
带状疱疹已在多种系统性自身免疫性疾病中广泛描述，但在皮肌炎/多发性肌炎中尚未见报道。因此，我们分析了该人群中带状疱疹的患病率、风险因素和带状疱疹结局。
对 1991 年至 2012 年在一家三级中心就诊的皮肌炎/多发性肌炎患者的带状疱疹感染进行了回顾性队列研究。为了对照组，每位带状疱疹患者匹配了两名无带状疱疹的患者。患者按性别和肌炎类型、肌炎发病年龄和病程进行匹配。
230 例患者中，24 例（10.4%）有带状疱疹病史（19 例为皮肌炎，5 例为多发性肌炎，三分之二为女性）。带状疱疹患者的平均年龄为 44.6±16.8 岁。两组间累积临床表现无差异。疾病活动度、自身抗体、肌肉和白细胞参数在两组间也相似。两组间免疫抑制治疗（单独或与其他免疫抑制治疗联合）或糖皮质激素（目前使用、近两个月内的中等剂量和累积剂量）治疗无差异。然而，与对照组相比，带状疱疹组中接受磷酸氯喹的患者比例更高。所有患者均接受阿昔洛韦治疗；58.3%的患者出现带状疱疹后神经痛，无复发病例。此外，在诊断带状疱疹时接受高剂量泼尼松治疗的个体，带状疱疹后神经痛的发生率较低。
这些数据表明，磷酸氯喹可能使皮肌炎/多发性肌炎患者易患带状疱疹，尤其是女性和皮肌炎患者。
