Shingles represents the reactivation of a previous viral infection with Herpes Zoster, the cause of Chicken Pox. Many adults have had infection with chicken pox as a child. Risk factors including aging and immunosuppression can lead to the reactivation of the virus usually along the course of a single nerve from the spine. Symptoms typically begin with a burning and painful sensations restricted to an area, with the formation of small blisters that then crust over. This can be extremely debilitating pain, and when it occurs on the face and around the eye can even threaten vision. Because this can occur in patients with immunosuppressive drugs, we do see a number of RA patients who have this problem when taking DMARDS, including nonbiological and biological drugs. The most important thing is recognition of the early symptoms because medications (such as acyclovir, famcyclovir) can shorten the duration and decrease longer term consequences if started early enough. Because of the risk of shingles, immunizations to prevent recurrence are recommended for patients BEFORE starting biological agents. This is a live virus vaccine that can potentially cause problems in patients on too much immunosuppression. The Centers for Disease control notes that the vaccine can be given to patients taking prednisone (up to 20 mg/day) and methotrexate.
Arthritis Associated with Other Illnesses Q & A
Great questions and complicated. Yes, the positive rheumatoid factor could be from hepatitis C but usually it is positive with hep C when you have arthritis and something called vasculitis. Doesn’t sound like the case for you. The positive RF could also represent pre-clinical RA. In other words, the blood test (RF) can be positive for years before the joint pain develops. One other test that can help is the anti-CCP antibody test. If that is positive, that makes the diagnosis of RA much more likely — meaning that the patient, even if aymptomatic now, is likely to develop it down the road. The anti-CCP test is usually negative in hepatitis C.
Someone with a very high titer ANA and a miscarriage should be evaluated by a rheumatologist. Even though there may not be enough symptoms to reach a dianosis of lupus, there is something brewing that needs to be evaluated and watched. Miscarriages are common in lupus and in something else called anti-phospholipid antibody syndrome (also called anti-cardiolipin antibody syndrome).
The technical term for what you have is “post-herpetic neuralgia” which is the pain that occurs even well after the skin lesions of shingles have healed. You should discuss therapies with your doctor. They range from topical therapies such as capsaicin cream or Lidoderm patches, to oral medications such as Neurontin, amitriptyline, NSAIDs, and codeine-like pain relievers.
Parvovirus B19 is a virus common in school age children particularly at this time of year. In children, it is often called Fifth’s Disease or erythema infectiosum. It presents as a fever and a flat red skin rash on the face “slapped cheeks” and occasionally on the palms and soles of the feet. By the time the rash appears, the child is ususally better and no longer infectious. For the most part, it is relatively a mild infection.
In adults, it can cause an inflammatory arthritis that looks very much like rheumatoid arthritis. Adults often lack the fever and rash. In general the arthritis starts to improve spontaneously by at least 6 weeks, occasionally a little longer. The arthritis can be debilitating and require prednisone to control symptoms. The IgM antibody test diagnoses acute infection, the IgG antibody test diagnoses exposure in the past. The IgM antibody should eventually clear and convert entirely over to IgG antibody. If the arthritis does not get beeter, other types of arthritis should be considered and the positive test for parvovirus IgM repeated.