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arthritis meds contribute to shingles outbreaks


Shingles Dermatome

Photograph by Fisle


Photograph by Fisle

One of the more common classes of drugs used to treat people with Rheumatoid Arthritis is called TNF (Anti-Tumor Necrosis Factor).  As the name sounds, it was originally used as a chemotherapy drug.  Dr. Kimme Hyrich and his team of researchers from the University of Manchester in England discovered some shocking news for those taking this class of medications.  The results were published in the February 2013 issue of Annals of the Rheumatic Diseases.

Approximately 12,000 patients taking TNF drugs for RHEUMATOID ARTHRITIS were looked at.  The three most common TNF drugs patients take for Rheumatoid Arthritis were the subject of the study.  They are…..

  • Generic name Etanercept, sold as Enbrel
  • Generic name Infliximab, sold as Remicade
  • Generic name Adalimumab, sold as Humira

Not only did the incidence of Shingles (Herpes Zoster) more than double for those taking the TNF drugs, their incidence of other skin infections increased as well.  Although some of this has to do with the disease itself (RA is an AUTOIMMUNE DISEASE), much of it has to do with the drugs that are given to treat it.  Because Autoimmune Diseases involve the body making antibodies against itself and then attacking itself, the drugs that are given are typically Immuno-suppressive.  Although CORTICOSTEROIDS are a popular Immuno-suppressive drug, there are many other drugs that could be classified as such, including TNF.

Furthermore, of the ‘severe’ cases of shingles (severe was defined as bad enough to require hospitalizations), 20 out of 21 cases were from the TNF group.  The TNF group’s Shingle patients were far more likely than the non-TNF group to have widespread (multi-dermatomal — see below) Shingles as well as Shingles in the eye.   But that’s not all.  The rates of other serious skin infections (Staph, Necrotizing Fasciitis, cellulitis, and others) went up significantly as well.


  • (1) Shingles starts out as a cluster of small bumps that can be either
  • (2) It turns into blisters that resemble chickenpox (you’ll see why in a moment)
  • (3) The blisters fill with fluid / pus, break open, and crust over
  • (4) They finally disappear (bear in mind that sometimes they leave scars).

This process typically takes about 3-6 weeks to run its course, with the acute phase (through #3 above) being finished within the first two weeks.   However, in some cases, a painful condition called post-herpetic neuralgia (post-Shingles nerve pain) can occur.  This form of neuralgia has the potential to be severe.

  • (5) This condition is caused by damage to the nerves, and can last from weeks to years after the rash / blisters disappear.


SHINGLES (sometimes referred to as “Zona”) is the name given to a disease similar to the Chicken Pox.  In fact, it is similar because it is caused by the same virus — Herpes Zoster.  Unfortunately, once you have Chicken Pox, the virus is not completely eliminated from the body.  Although they can live in just about any nerve, the virus tends to travel to the nerve roots (where the nerves come off the spinal cord) and go dormant — sometimes for decades.  In about one in three people, the virus is awakened sometime during the course of their lifetime.  The result is Shingles.

Due to any number of factors (stress probably being the biggest), the dormant Herpes virus is awakened and again becomes active.  It tends to follow a “Dermatomal” pattern.  That is, it will follow the pattern of the nerve(s) it was living in.  You can often see this when you compare the Dermatome Diagram (on the right) to the distribution of the outbreak.  This is why Shingles is rarely found in a random pattern.

In the near future, I plan on doing a post on natural ways to prevent Shingles if you have not yet had them, or make their duration shorter and less intense if you do have them.


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