Detailed characteristics of patients experiencing an RA flare within 12 weeks of HZ vaccination.
| Sex/Age | RF, IU/ml*/ACPA, U/ml† | Remission Duration‡, mos | Medication | Baseline DAS28 | TJC/SJC | Onset, wk | Flare DAS28 | TJC/SJC | Location | Remark |
|---|---|---|---|---|---|---|---|---|---|---|
| F/60 | 55.2/– | 8.8 | MTX 7.5 mg, PSL 7.5 mg | 1.0 | 0/0 | 7 | 2.8 | 1/1 | Right knee | Positive joint effusion: WBC 9000/μl; IA triamcinolone; started anti–TNF-α therapy 20 wks later |
| F/55 | 5.8/> 100 | 26.2 | MTX 7.5 mg, LEF 10 mg, PSL 2.5 mg | 1.0 | 0/0 | 12 | 2.9 | 2/2 | Left 2nd, 3rd MCP | Recovered spontaneously |
| F/61 | 13.3/329 | 7.3 | LEF 10 mg, PSL 10 mg | 1.1 | 0/0 | 9 | 2.5 | 1/1 | Right shoulder | Biceps tenosynovitis on ultrasound; IA triamcinolone injection |
| F/56 | 103.4/303 | 10.0 | MTX 10 mg, SSZ 1 g | 2.0 | 0/0 | 12 | 3.4 | 2/2 | Both 2nd MCP | Right ankle synovitis on ultrasound; started anti–TNF-α therapy 5 wks later |
| F/67 | 2.9/< 0.05 | 33.0 | MTX 10 mg | 1.1 | 0/0 | 9 | 2.6 | 2/2 | Left 2nd, 3rd PIP | Recovered spontaneously |
| F/54 | 160.7/– | 14.7 | SSZ 1 g | 1.1 | 0/0 | 12 | 3.4 | 6/2 | Both wrists | Added PSL 5 mg, temporary |
↵* Reference range, 0–20 IU/ml.
↵† Reference range, < 7 U/ml.
↵‡ Duration of remission calculated from the last flare to the time of HZ vaccination. ACPA: anticitrullinated protein antibodies; IA: intraarticular injection; DAS28: 28-joint Disease Activity Score; HZ: herpes zoster; LEF: leflunomide; MCP: meta-carpophalangeal joint; MTX: methotrexate; PSL: prednisolone; PIP: proximal interphalangeal joint; RF: rheumatoid factor; SJC: swollen joint count; SSZ: sulfasalazine; TJC: tender joint count; TNF-α: tumor necrosis factor–α; WBC: white blood cells; RA: rheumatoid arthritis.