Objective To explore whether varicella zoster virus (VZV) infection could increase the risk of disease flares in patients with SLE.
Methods Patients who had VZV reactivations between January 2013 and April 2018 were included from the SLE database (n=1901) of Shanghai Ren Ji Hospital, South Campus. Matched patients with SLE were selected as background controls with a 3:1 ratio. Patients with SLE with symptomatic bacterial infections of the lower urinary tract (UTI) were identified as infection controls. Baseline period and index period were defined as 3 months before and after infection event, respectively. Control period was the following 3 months after the index period. Flare was defined by SELENA SLEDAI Flare Index. Kaplan-Meier analysis, Cox regression model and propensity score weighting were applied.
Results Patients with VZV infections (n=47), UTI controls (n=28) and matched SLE background controls (n=141) were included. 16 flares (34%) in the VZV group within the index period were observed, as opposed to only 7.1% in UTI controls and 9.9% in background controls. Kaplan-Meier curve revealed that patients with a VZV infection had a much lower flare-free survival within the index period compared with the controls (p=0.0003). Furthermore, after adjusting for relevant confounders including baseline disease activity and intensity of immunosuppressive therapy, Cox regression analysis and propensity score weighting confirmed that VZV infection within 3 months was an independent risk factor for SLE flares (HR 3.70 and HR 4.16, respectively).
Conclusions In patients with SLE, recent VZV infection within 3 months was associated with increased risk of disease flares.
- systemic lupus erythematosus
- disease flares
- varicella zoster virus infections
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Contributors All authors participated in drafting and revising the article, and all authors approved the final version for publication. SY had full access to all the data in the study and takes responsibility for the integrity and accuracy of the data. Study design: SY. Acquisition of data: FS, YC, WW, LiG. Analysis and interpretation of data: FS, YC.
Funding FS has received funding from Ren Ji Hospital South Campus, School of Medicine, Shanghai Jiaotong University (2016PWGZR03), and the Health and Family Planning Commission of Shanghai Minhang District (2018MW54). SY has received funding from Shanghai Shenkang promoting project for clinical skills of major diseases (16CR1013A).
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The retrospective study protocol was approved by the ethics committees of Ren Ji Hospital.
Provenance and peer review Not commissioned; externally peer reviewed.
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