{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T01:58:16Z","timestamp":1791165496285,"version":"4.1.0"},"reference-count":52,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2017,7]]},"abstract":"\n Background<\/jats:title>\n \n Accumulating evidence suggests an increased risk of stroke after herpes zoster (\n HZ<\/jats:styled-content>\n ). This risk is elevated in immunocompromised patients. The incidence of\n HZ<\/jats:styled-content>\n in Asia is higher than in Western countries. However, the epidemiology of\n HZ<\/jats:styled-content>\n and\n HZ<\/jats:styled-content>\n \u2010related stroke among rheumatoid arthritis (\n RA<\/jats:styled-content>\n ) patients in Asia remains unclear.\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n We conducted a retrospective cohort study using a population\u2010based database to investigate the epidemiology of\n HZ<\/jats:styled-content>\n in\n RA<\/jats:styled-content>\n patients in Taiwan during the period of 2000\u20102011. A total of 27\u00a0609 newly diagnosed and eligible\n RA<\/jats:styled-content>\n cases were identified, and 110\u00a0436 non\u2010\n RA<\/jats:styled-content>\n cases were matched for age and sex at a ratio of 4:1.\n HZ<\/jats:styled-content>\n risk increased by 2.53\u2010fold (\n P<\/jats:italic>\n <0.0001) in\n RA<\/jats:styled-content>\n patients compared with the general population. Exposure to corticosteroids (adjusted odds ratio=1.73,\n P<\/jats:italic>\n <0.0001), adalimumab (adjusted odds ratio=1.61,\n P<\/jats:italic>\n =0.002), and rituximab (adjusted odds ratio=2.06,\n P<\/jats:italic>\n =0.008) was associated with an increased risk of\n HZ<\/jats:styled-content>\n in\n RA<\/jats:styled-content>\n patients. A significant association between the use of methotrexate or corticosteroids and\n HZ<\/jats:styled-content>\n risk was dose\u2010dependent (\n P<\/jats:italic>\n trend<\/jats:sub>\n <0.0001). Elevated risk of stroke was observed in\n RA<\/jats:styled-content>\n patients with\n HZ<\/jats:styled-content>\n (adjusted hazard ratio=1.27,\n P<\/jats:italic>\n =0.047), particularly in those with neurological complications (adjusted hazard ratio=1.54,\n P<\/jats:italic>\n =0.015). A 2.30\u2010fold significantly increased risk of stroke within 90\u00a0days after\n HZ<\/jats:styled-content>\n occurrence was observed in\n RA<\/jats:styled-content>\n patients compared with those without\n HZ<\/jats:styled-content>\n (\n P<\/jats:italic>\n =0.02). Furthermore, death risk increased in\n RA<\/jats:styled-content>\n patients with\n HZ<\/jats:styled-content>\n (adjusted hazard ratio=1.18,\n P<\/jats:italic>\n =0.026).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n The risk of\n HZ<\/jats:styled-content>\n and\n HZ<\/jats:styled-content>\n \u2010related stroke has increased in\n RA<\/jats:styled-content>\n patients. Monitoring the occurrence of\n HZ<\/jats:styled-content>\n in\n RA<\/jats:styled-content>\n patients and preventing\n HZ<\/jats:styled-content>\n \u2010related stroke or mortality during a specific immunosuppressive therapy are important.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.117.006304","type":"journal-article","created":{"date-parts":[[2017,7,20]],"date-time":"2017-07-20T00:10:18Z","timestamp":1500509418000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":26,"title":["Significant Associations of Neurological Complications of Herpes Zoster With Stroke in Rheumatoid Arthritis Patients"],"prefix":"10.1161","volume":"6","author":[{"given":"Tsai\u2010Ling","family":"Liao","sequence":"first","affiliation":[{"name":"Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan"},{"name":"Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ching\u2010Heng","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan"},{"name":"National Taipei University of Nursing and Health Science, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hsin\u2010Hua","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan"},{"name":"Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan"},{"name":"Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan"},{"name":"Faculty of Medicine, National Yang Ming University, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi\u2010Ming","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan"},{"name":"Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan"},{"name":"Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan"},{"name":"Faculty of Medicine, National Yang Ming University, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Che\u2010Chen","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Der\u2010Yuan","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Medical Education, Taichung Veterans General Hospital, Taichung, Taiwan"},{"name":"Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan"},{"name":"Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan"},{"name":"Faculty of Medicine, National Yang Ming University, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp058091"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1086\/320169"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(03)00857-0"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.1038\/srep14008"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198312083092306"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.4065\/84.9.787"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2008.089276"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.1002\/art.23112"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.1086\/598331"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2009.146"},{"key":"e_1_3_5_12_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.1099"},{"key":"e_1_3_5_13_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2014-004833"},{"key":"e_1_3_5_14_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.109.562017"},{"key":"e_1_3_5_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2015.09.015"},{"key":"e_1_3_5_16_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0166554"},{"key":"e_1_3_5_17_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.115.012052"},{"key":"e_1_3_5_18_2","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780310302"},{"key":"e_1_3_5_19_2","doi-asserted-by":"publisher","DOI":"10.1002\/art.39855"},{"key":"e_1_3_5_20_2","doi-asserted-by":"publisher","DOI":"10.2147\/PPA.S94396"},{"key":"e_1_3_5_21_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciw296"},{"key":"e_1_3_5_22_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0077709"},{"key":"e_1_3_5_23_2","doi-asserted-by":"publisher","DOI":"10.4065\/82.11.1341"},{"key":"e_1_3_5_24_2","doi-asserted-by":"publisher","DOI":"10.1002\/jmv.10313"},{"key":"e_1_3_5_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2009.11.029"},{"key":"e_1_3_5_26_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM195310012491402"},{"key":"e_1_3_5_27_2","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kes305"},{"key":"e_1_3_5_28_2","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2014-205675"},{"key":"e_1_3_5_29_2","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2011-200726"},{"key":"e_1_3_5_30_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11739-015-1250-4"},{"key":"e_1_3_5_31_2","doi-asserted-by":"publisher","DOI":"10.1111\/bjd.14815"},{"key":"e_1_3_5_32_2","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2008.093690"},{"key":"e_1_3_5_33_2","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kep101"},{"key":"e_1_3_5_34_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2249.1999.00753.x"},{"key":"e_1_3_5_35_2","first-page":"696","article-title":"Corticosteroid use in rheumatoid arthritis: prevalence, predictors, correlates, and outcomes","volume":"34","author":"Caplan L","year":"2007","unstructured":"Caplan L, Wolfe F, Russell AS, Michaud K. Corticosteroid use in rheumatoid arthritis: prevalence, predictors, correlates, and outcomes. J Rheumatol. 2007;34:696\u2013705.","journal-title":"J Rheumatol"},{"key":"e_1_3_5_36_2","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2011-200702"},{"key":"e_1_3_5_37_2","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.immunol.19.1.65"},{"key":"e_1_3_5_38_2","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2013-204573"},{"key":"e_1_3_5_39_2","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0b013e318211106a"},{"key":"e_1_3_5_40_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.semarthrit.2005.01.004"},{"key":"e_1_3_5_41_2","doi-asserted-by":"publisher","DOI":"10.1084\/jem.20052283"},{"key":"e_1_3_5_42_2","doi-asserted-by":"publisher","DOI":"10.1002\/art.22025"},{"key":"e_1_3_5_43_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200003023420906"},{"key":"e_1_3_5_44_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMicm010341"},{"key":"e_1_3_5_45_2","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000304747.38502.e8"},{"key":"e_1_3_5_46_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.47.2.569"},{"key":"e_1_3_5_47_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000089015.51603.CC"},{"key":"e_1_3_5_48_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jns.2015.09.349"},{"key":"e_1_3_5_49_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e31827b1ab9"},{"key":"e_1_3_5_50_2","doi-asserted-by":"publisher","DOI":"10.5858\/2001-125-0770-VZVIOT"},{"key":"e_1_3_5_51_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000002808"},{"key":"e_1_3_5_52_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2016-014032"},{"key":"e_1_3_5_53_2","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keh464"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.117.006304","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T10:32:01Z","timestamp":1715596321000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.117.006304"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,7]]},"references-count":52,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2017,7]]}},"alternative-id":["10.1161\/JAHA.117.006304"],"URL":"https:\/\/doi.org\/10.1161\/jaha.117.006304","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,7]]},"assertion":[{"value":"2017-04-07","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-05-24","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-07-19","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e006304"}}