Systematic review and meta-analysis of herpes zoster risk in rheumatoid arthritis patients

The co-occurrence of herpes zoster (HZ) in patients with rheumatoid arthritis (RA) represents a significant public health concern, with notable implications for both physical and mental health. This meta-analysis aims to systematically evaluate the pooled proportion of HZ in RA patients and identify associated factors. A comprehensive literature search was conducted across eight databases: PubMed, Web of Science, Embase, Cochrane Library, CNKI, VIP, WANFANG Data, and CBM. The review was conducted in accordance with PRISMA guidelines, and the quality of included studies was assessed using the Newcastle-Ottawa Scale (NOS). All statistical analyses were performed using Stata 17.0. A total of 17 observational studies (seven case-control and ten cohort) comprising 472,150 patients were included in this meta-analysis, indicating a descriptive pooled proportion of herpes zoster of 6% (95% CI: 4%-8%). However, the 95% prediction interval was 5% to 45%, reflecting substantial heterogeneity. This estimate represents an average across diverse settings rather than a universally generalizable figure. Eleven potential factors were evaluated, and the results indicated that the following were significantly associated with HZ in RA patients: female gender (OR = 1.47, 95% CI, 1.15-1.89, P = 0.002), age (OR = 1.12, 95% CI, 1.02-1.22, P = 0.012), corticosteroid dosage ≥7.5 mg/day (OR = 2.16, 95% CI, 1.85-2.53, P < 0.001), corticosteroid use (OR = 1.42, 95% CI, 1.19-1.69, P < 0.001), use of tumor necrosis associated factor inhibitors (OR = 1.94, 95% CI, 1.43-2.63, P < 0.001), methotrexate use (OR = 1.68, 95% CI, 1.39-2.02, P < 0.001), hydroxychloroquine use (OR = 2.67, 95% CI, 1.24-5.74, P = 0.012), history of pulmonary disease (OR = 1.42, 95% CI, 1.10-1.83, P = 0.007), history of hypertension (OR = 1.43, 95% CI, 1.15-1.77, P = 0.001), history of kidney disease (OR = 1.30, 95% CI, 1.04-1.62, P = 0.022), and history of heart disease (OR = 2.30, 95% CI, 1.17-4.52, P = 0.016). Our meta-analysis indicates that the observed 6% pooled proportion of HZ in patients with RA constitutes a significant burden compared to the general population, highlighting the necessity for timely prevention. Moreover, when assessing HZ risk, factors such as female gender, age, corticosteroid use and dosage ≥7.5 mg/day, use of tumor necrosis factor inhibitors, methotrexate, hydroxychloroquine, and a history of pulmonary disease, hypertension, kidney disease, or heart disease should be carefully considered. These findings highlight the need for further research into the associated factors and underlying biological mechanisms of HZ in RA patients and support the development of targeted prevention strategies that address modifiable risks. https://www.crd.york.ac.uk/PROSPERO/view/, identifier CRD420251050627.