RT Journal Article SR Electronic T1 Varicella zoster virus infections increase the risk of disease flares in patients with SLE: a matched cohort study JF Lupus Science & Medicine JO Lupus Sci Med Lupus Sci Med FD Lupus Foundation of America SP e000339 DO 10.1136/lupus-2019-000339 VO 6 IS 1 A1 Fangfang Sun A1 Yi Chen A1 Wanlong Wu A1 Li Guo A1 Wenwen Xu A1 Jie Chen A1 Shuhui Sun A1 Jiajie Li A1 Zhiwei Chen A1 Liyang Gu A1 Xiaodong Wang A1 Ting Li A1 Shuang Ye YR 2019 UL http://lupus.bmj.com/content/6/1/e000339.abstract AB 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.