What is the risk of getting shingles for patients with rheumatoid arthritis?
Shingles (herpes zoster) is a painful rash caused by the reactivation of the chickenpox virus. People with rheumatoid arthritis (RA) have a higher risk of shingles because their immune system is altered by the disease and by some treatments. A large analysis of 17 studies found that about 6% of RA patients had shingles, though the range across studies was wide (5% to 45%) 1. Another study using German health records showed that RA patients had about a 30% higher risk of shingles compared to people without any chronic condition 9. This means RA itself is a risk factor, and certain medications can further increase that risk.
What the research says
A 2024 meta-analysis of 17 observational studies including over 472,000 RA patients found a pooled proportion of herpes zoster of 6% (95% CI: 4%-8%) 1. However, the prediction interval was very wide (5% to 45%), meaning the true rate varies greatly depending on the patient group and setting. The same analysis identified several factors that increase the risk: being female (about 47% higher odds), older age, and taking corticosteroids at a dose of 7.5 mg/day or more (more than double the odds) 1.
A separate German claims study from 2021 confirmed that RA carries one of the highest risks for shingles among chronic conditions. Compared to people with no underlying condition, RA patients had a 37% to 57% higher odds of developing shingles, depending on age group 9. This study also noted that having multiple chronic conditions further increases the risk 9.
Some RA treatments, especially biologic drugs like TNF blockers (e.g., adalimumab), can also raise the risk of shingles. The prescribing information for adalimumab lists serious infections, including herpes zoster, as a possible side effect 3. The meta-analysis did not specifically analyze biologic use, but it did find that corticosteroid use above 7.5 mg/day was a strong risk factor 1.
It is important to note that the other sources provided do not directly address shingles risk. They cover topics like plant-derived vesicles 2, sinomenine 4, RNA methylation 5, transposable elements 6, team-based care 7, and diagnostic algorithms 8 — none of which contain data on shingles in RA.
What to ask your doctor
- Given my RA, what is my personal risk of getting shingles?
- Do any of my current RA medications (especially steroids or biologics) increase my shingles risk?
- Should I consider getting the shingles vaccine? If so, which one and when?
- What early signs of shingles should I watch for, and how quickly should I seek treatment?
- If I get shingles, will my RA treatment need to be paused or changed?
This question is drawn from common patient questions about Rheumatology and answered using cited medical research. We do not provide individualized advice.