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Shingles, also known as Herpes Zoster,
is a reactivation of the virus that causes chicken pox.
After an individual gets chicken pox,
the virus essentially goes to sleep.
It becomes dormant in the body.
For some people, that's pretty much the end of the story.
It just stays dormant for the rest of their life.
However, in other patients,
the virus can essentially wake up,
and when it does that,
it produces a very painful rash on the body,
and that's what we refer to as Shingles or Herpes Zoster.
So if you imagine,
you kind of draw a line down your body in the middle
with left and right halves,
the rash typically presents only on one side of the body,
and it can be very painful.
The rash is most commonly located on the torso,
the chest and back area,
but can also be present on the limbs, as well as the face.
One of the more concerning areas it can present
is on or around the eye.
When that happens, we typically need an eye doctor
to be involved in the care of the patient.
It's very important to note that the pain of Shingles
can sometimes precede the appearance of a rash
for days or even weeks.
This typically occurs in patients who have
a weakened immune system,
which occurs naturally as people age,
but also can occur if patients are taking
certain immune-suppressing medications,
or another way of saying that is medications
that impair the function of your immune system.
So we generally say patients
who that are over the age of 50 and older
as well as those on medication
such as high doses of steroids or methotrexates,
azathioprine, mycophenolate, et cetera, there are many,
are at increased risk for developing this.
The treatment for Shingles includes antiviral therapy
that's targeted directly at the Herpes virus
that causes the infection.
It's important that this treatment
is administered as soon as possible,
ideally within 72 hours from the onset of symptoms.
The importance of rapid treatments
is to prevent complications.
One complication that many people worry about
is something called postherpetic neuralgia.
What this is is basically persistent pain
at the site where the rash is.
This pain, unfortunately, can last months, even years,
long after the rash has resolved.
So that's the main complication
that early treatments is hoping to prevent.
Shingles is even more relevant
for patients who have an underlying rheumatic disease.
As I mentioned before,
medications often used to treat these patients
impair the function of the immune system,
which is one of the main risk factors
for developing Shingles.
So patients who are on many medications,
including high doses of steroids, methotrexate,
azathioprine, mycophenolate, the list is quite long,
those are all medications
that increase the risk of developing it.
So, there is a vaccine that can help prevent
the occurrence of Shingles.
The vaccine is approved for those over the age of 50
and recommend for those over the age of 60.
However, there are patients under the age of 50
that are at risk of developing shingles.
As we mentioned before,
patients on certain types of medications.
So it may be appropriate for them to receive this vaccine.
Patients who have underlying rheumatic disease
and are being treated with medications
are allowed to receive the vaccine,
but only in certain situations.
In general, patients need to be on very low doses
of medications that impact the immune system
to be able to receive the vaccine safely,
and this is a very individualized decision.
Depends on the patient's underlying disease,
what specific medications they are on,
so they should absolutely be speaking
to their rheumatologist about whether it's appropriate
for them to consider this vaccine.
So there's a lot of exciting work being done in this field.
There are currently ongoing studies
looking at whether patients can safely receive
the Zosters vaccine while receiving higher doses
of immune medications.
In addition, there are different types
of Zoster vaccines being produced
that might provide safer alternatives
to patients receiving medications.
Overall, we like patients to be aware
of what Shingles is, how it can present,
and the important of early treatment.
Particularly for patients who have
an underlying rheumatic disease
and are being treated with medications,
we want them to remember that it is safe
to receive the vaccine,
but only under the guidance of their rheumatologist.
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