Abstract
Background: The prevalence of herpes zoster (HZ) is high in patients with rheumatic diseases. Systemic lupus erythematosus (SLE) doubles the risk for developing HZ. However, little is known about natural humoral immunity against varicella zoster virus (VZV) in patients with SLE. Hence, we compared VZV IgG antibody concentrations in a group of SLE patients with healthy controls and patients with rheumatoid arthritis (RA). Methods: n = 56 patients with SLE, n = 54 patients with RA, and n = 56 healthy controls were included in this study. The VZV IgG antibody concentration was measured using an enzyme-linked immunosorbent assay (ELISA). The antibody concentrations were compared between the groups. Results: Overall IgG antibody titers for VZV in SLE patients were comparable to healthy controls but higher when compared to patients with rheumatoid arthritis (p = 0.0012). In consequence, antibody levels in controls were higher than in RA patients (p = 0.0097). Stratification by age revealed highest titers among SLE patients in the fourth life decade (p = 0.03 for controls, p = 0.0008 for RA patients) whereas RA patients in their sixth decade had the lowest antibody concentration (p = 0.03 for controls, p = 0.04 for SLE patients). Regarding the individual HZ history, antibody levels of SLE patients with a positive history exceeded all other groups. Conclusions: Although humoral VZV immunity in SLE patients is comparable to healthy controls it seems to be pronounced in young SLE patients between 30 and 39. The lowest VZV IgG levels were found in RA patients. HZ seems to induce antibody production, particularly in patients with SLE. Immunological processes might contribute to VZV antibody levels in SLE patients, but further investigations are needed to substantiate this hypothesis. Even though the increased HZ prevalence seems to be independent of humoral immunity in SLE patients, reduced humoral immunity might contribute to HZ in RA patients. The available HZ subunit vaccination might be an appropriate way to reduce the HZ risk in patients with rheumatic diseases.
Highlights
With a lifetime risk of 20–30% in general and up to 50% in people reaching 85 years of age [1], herpes zoster (HZ, shingles) is a relevant clinical problem
We previously demonstrated that varicella zoster virus (VZV) antibody avidity is decreased in rheumatoid arthritis (RA) patients compared to matched controls [29]
Antibody levels of Systemic lupus erythematosus (SLE) patients with a positive history were higher than in controls. These findings emphasize the impact of a prior HZ on the VZV antibody levels in SLE patients, they imply the existence of SLEspecific reasons
Summary
With a lifetime risk of 20–30% in general and up to 50% in people reaching 85 years of age [1], herpes zoster (HZ, shingles) is a relevant clinical problem. The relevance of HZ is high in patients with inflammatory rheumatic diseases Within this large group, patients with systemic lupus erythematosus (SLE, relative risk (RR) up to 4.11) and rheumatoid arthritis (RA, RR up to 2.4) show a increased risk for acquiring HZ [4,5,6]. We compared VZV IgG antibody concentrations in a group of SLE patients with healthy controls and patients with rheumatoid arthritis (RA). Results: Overall IgG antibody titers for VZV in SLE patients were comparable to healthy controls but higher when compared to patients with rheumatoid arthritis (p = 0.0012). The available HZ subunit vaccination might be an appropriate way to reduce the HZ risk in patients with rheumatic diseases
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