Methotrexate and shingles

[Tinksie]

Hi everyone. I vaguely remember being told to try to stay away from people with chicken pox or shingles whilst on methotrexate. Can anyone tell me if this is true and if so why?! I'm on methotrexate and have spent some time with my close friend who had shingles and am wondering if I should be being careful but it's not contagious so don't see why?? Can anyone help??! Xx

[whisperit]

My understanding is that shingles is less infectious than chickenpox (even though it is caused by the same virus), so the precautions against transmission are less rigorous. However, you can catch shingles by direct skin contact with the infected area.

If you are on steroids, any shingles infection is likely to be severe owing to your suppressed immune response. That's why you are advised to contact a doctor promptly, in case antiviral treatment is needed.

(this is my understanding from the NICE guidance)

x

[Tinksie in reply to whisperit]

Thanks for responding. I'm already suffering with a bad cold/fever so probably feeling more worried than necessary. X

[PMRpro]

When you are on immunosuppressants your immune system may not fight off any infection so effectively - mtx is an immunosuppressant.

If you did not have CP as a child it could mean that you are more likely to catch it if in contact with CP patients - although the most infectious time is up to 48 hours before the first spot appears when you don't KNOW it is CP, it could still be just a cold! And you could sit next to them on the bus - and never know. Really not very practical advice is it?

Theoretically, if you haven't had CP as a child, you CAN catch CP from someone with shingles - it is contagious if you come in contact with the fluid from the shingles rash and then transfer the fluid to your mouth/nose. However, practically speaking, it has not been recorded as having happened (according to the experts, no, don't mock...). YOU cannot CATCH shingles - you must have had CP in the past and it is a reawakening of the virus which was dormant in nerve endings in the body.

There is usually no point rushing to the GP immediately - what they usually do is give antiviral medication WHEN THE SYMPTOMS APPEAR which should shorten the course and reduce the severity of the infection, but it doesn't work as a prophylactic (to prevent the infection), the virus must be active, so it isn't given in advance.

IF you are severely immunocompromised then they can give immunoglobulin as a prophylactic but that is rarely done, usually for post transplant patients or the like.

If you are worried, you could ask your GP for a script for the antiviral stuff - it needs to be started within 48 hours of symptoms appearing and the incubation period is usually 14-21 days.

[Tinksie]

Thanks for taking the time to write that - very helpful. It's reassuring to know that they wouldn't do anything til symptoms appear anyway. Will just be extra vigilant and go see GP at first sign of any symptoms. X

[whisperit in reply to Tinksie]

yes, that's what my GP said when he suspected shingles the other day. I had a burning sensation on my stomach, but no rash. He said to return straight away if there was any sign of a rash and then he would probably prescribe an av.

[PMRpro in reply to whisperit]

Hmm - he didn't know you can have shingles without the rash then? It is rare - but it happens.

[whisperit in reply to PMRpro]

i guess not!

[Poshcards]

I have been told by my consultant to stay away from all infections, coughs, colds, child ailments etc. As our immune systems cannot fight them whilst on metho. Also not to take it if you have infection or bad cough until you feel well again. Hope this helps x

[Tinksie in reply to Poshcards]

Thank you for that. I will definitely talk to my Rheumy about it next time. I have a bad cough/cold at the moment and am antibiotics but the GP didn't say anything about coming off the methotrexate. I also inject weekly so it's not something I could come off immediately. I'm asthmatic so the cough is worse for that reason so maybe they feel it's not necessary - it's a minefield this Lupus life! X

[Poshcards in reply to Tinksie]

You need to question your Rheumy consultant, my GP never said anything either, its was the consultant at the hospital when I was rushed in twice with Pneumonia. Good luck and Merry Christmas x