A Review of the Awareness of Herpes Zoster Infection in Patients with Rheumatic Diseases Taking JAK Inhibitors

Abstract

Background Herpes zoster (HZ), commonly known as shingles, is caused by the reactivation of the Varicella-zoster virus (VZV), the same virus that causes chickenpox. Approximately one-third of the population experiences shingles at least once in their lifetime. While age is the primary risk factor, immunocompromised individuals, such as patients with rheumatic diseases are particularly susceptible, especially those treated with Janus kinase inhibitors (JAKi). Real-world data from the Hong Kong Biologics Registry 2023 reported a herpes zoster infection rate of 3.49 per 100 patient-years among rheumatoid arthritis patients. This study aims to determine the rate of HZ infection among these patients and in particular, to assess their self-management strategies for HZ infection in a regional hospital. Methods This retrospective study involved patients diagnosed with rheumatoid arthritis, Spondyloarthritis and Psoriatic Arthritis, who were receiving JAKi treatments (Tofacitinib, Baricitinib and Upadacitinib). Participants were interviewed at the Rheumatology nurse clinic or by phone. A questionnaire gathered data on patient age, HZ vaccination status, history of HZ post JAKi initiation, and self-management plans for HZ infections. Results As of July 2024, a total number of 52 patients were interviewed. 33 (63.5%) had received the HZ vaccine prior to starting of JAKi, while 19 (36.5%) had not. 4 (7.7%) of them developed HZ after initiating treatment, with ages ranging from 46-84. 19 (36.5%) of them would seek medical advice if they have HZ infection, 7 (13.5%) would consult a doctor and consider withholding JAKi treatment. 3 (5.8%) would only stop the medication, 23 (44.2%) of them were uncertain about their actions. Conclusion This study demonstrates an increased risk of HZ infection among these patients and most importantly, highlights a critical gap in patient knowledge about HZ prevention and management. There is a clear need to enhance patient education regarding raising awareness of HZ risks, promoting vaccination, and providing effective self-management strategies.