Should I Get the Shingles Vaccine If I Have Psoriatic Arthritis?

Psoriatic arthritis (PsA) is an autoimmune disorder that leads to inflammation of the joints. It occurs in combination with psoriasis, but usually as a later complication. Commonly affected joints include the fingers, toes, wrists, and ankles. In a small number of patients, joint symptoms start prior to skin symptoms.

Shingles is a painful, burning rash that occurs along a nerve root. It is a viral outbreak that typically occurs later in life from reactivation of the virus that causes chickenpox (herpes zoster). After having chickenpox, the virus stays in your body and usually doesn’t cause any problems. However, the virus can reemerge as shingles later in life.

People with psoriasis and PsA seem to be at a higher risk of developing shingles than the general population. This article discusses the link between PsA and shingles, including the types of shingles vaccines and the benefits and risks of vaccination.

The Link Between Psoriatic Arthritis and Shingles

Studies have shown that people with autoimmune or inflammatory diseases like psoriasis and psoriatic arthritis are more likely to develop shingles. This risk seems more prominent in people who take immunosuppressive medications to control their disease, specifically:

• Glucocorticoids
• Methotrexate
• Xeljanz (tofacitinib)
• Tumor necrosis factor-alpha (TNF-alpha) inhibitors

Therefore, people with psoriasis and psoriatic arthritis should strongly consider protecting themselves from shingles with vaccination.

In addition, it seems that people with underlying psoriasis who develop shingles could have worsening skin symptoms in the location of the shingles rash.

One of the most common causes of a psoriasis flare is stress. This stress can include skin injury or harm.

People can develop psoriatic lesions in areas where there was a previous scratch, insect bite, or sunburn. This trigger is called the Koebner phenomenon. Shingles lesions cause skin damage in a way that can lead to new psoriasis lesions.

Types of Shingles Vaccines

Since people with psoriasis and psoriatic arthritis, especially those who take immunosuppressive medications, appear to be at increased risk for herpes zoster infection and shingles, the National Psoriasis Foundation recommends shingles vaccination in all people over age 50 and in younger people with weakened immunity.

Previously, there were two shingles vaccine options: Shingrix and Zostavax. However, Zostavax is no longer available for use in the United States.

Shingrix

Shingrix is the only vaccine available in the United States for protection against shingles. It is a recombinant vaccine, which means it uses part of the herpes zoster virus to create an immune response. Shingrix is not a live vaccine, and a person cannot develop shingles from the vaccine. 

The Shingrix vaccine is a two-shot series. People should obtain the second injection two to six months after the first injection.

The vaccine is 90% effective at preventing shingles and its painful complication, postherpetic neuralgia.

The Shingrix vaccine is recommended for:

• All adults 50 years and older
• Adults age 19 and older with weakened immune systems due to underlying disease or medications

The shingles vaccine is even recommended if a person:

• Had shingles in the past
• Received Zostavax previously
• Received the chickenpox vaccine

Zostavax

Zostavax is a live vaccine that was recommended for people age 60 and older to prevent shingles. However, the vaccine is no longer available for use in the United States. 

Zostavax is a live vaccine, and live vaccines can be problematic for people with immune system disorders and immunodeficiency caused by their disease or medications. A live vaccine can potentially lead to actual infection after vaccination in people with weak immunity. Since people with psoriatic arthritis often take immune-modulating medicines, Zostavax would not be a good choice for vaccination. 

Benefits of the Shingles Vaccine

Shingles can be life-threatening or lead to severe problems, such as pneumonia, hearing problems, or encephalitis (swelling of the brain), but these are extremely rare.

More often, shingles can be debilitating due to the severe pain associated with the skin lesions. A person can develop postherpetic neuralgia, chronic pain in the area of the previous rash. Vaccination with Shingrix can prevent all of these problems. 

The shingles vaccine is very effective. In people with healthy immune systems age 50–69 years, the Shingrix vaccine is:

• 97% effective in preventing shingles
• 91% effective in preventing postherpetic neuralgia
  

In people age 70 years and older, the Shingrix vaccine is:

• 91% effective in preventing shingles
• 89% effective in preventing postherpetic neuralgia
  

However, people with autoimmune disorders and those who take immunosuppressive medications might not benefit as much, since they often cannot build strong immunity with vaccination. Still, a study of vaccine effectiveness in people with autoimmune disorders like psoriasis and PsA found that the vaccine was:

• 90.5% effective overall
• 84.4% effective in people age 70–79
  

Many people with psoriasis and PsA do not take immunosuppressive therapy to control their disease. Therefore, the Medical Board of the National Psoriasis Foundation recommends shingles vaccination for:

• All people over age 50 
• People age 50 and under if they are taking Xeljanz (tofacitinib), systemic steroids (glucocorticoids), or combination systemic treatment
  

People taking other systemic therapies for psoriasis or PsA should consider vaccination on a case-by-case basis and in consultation with a healthcare provider.

Risks of the Shingles Vaccine

Experts agree that the shingles vaccine is safe for people with psoriasis and PsA. The Shingrix vaccine is not a live vaccine, so there is no risk for infection with herpes zoster from the vaccine. Vaccination is only potentially harmful in people:

• With an active shingles outbreak
• Who are pregnant
• Who had a previous allergic reaction to the Shingrix vaccine or any of its components
  

Side effects of the vaccine are the same as the side effects with any vaccination. These include:

• Sore arm
• Fatigue
• Muscle aches
• Headache
• Chills or fever
• Stomach pain
• Nausea  
  

These symptoms typically resolve within two to three days and are treated with over-the-counter (OTC) medicines like Tylenol (acetaminophen) and Motrin or Advil (ibuprofen).

There is a slight risk of developing Guillain-Barre syndrome after Shingrix vaccination. This disorder is associated with weakness and sensory problems, typically starting in the legs, from damage to the nervous system.

Is the Shingles Vaccine Right for Me?

Each person is unique, so various factors will determine if the shingles vaccine is right for you, including:

• Severity of your autoimmune disease
• Medications you take
• Other medical problems that might put you at risk for infection
• Tolerability for vaccination

The best way to determine whether shingles vaccination is right for you is to speak with your healthcare provider. Most likely, your provider will recommend vaccination.

Summary

People with psoriasis and psoriatic arthritis are at increased risk for developing shingles, a painful, burning rash from infection with the herpes zoster virus. In addition, people with psoriasis who develop shingles can develop worsening skin lesions. Therefore, vaccination against shingles is recommended, especially for people taking immunosuppressive therapy. 

Vaccination not only prevents life-threatening and severe problems associated with shingles but protects a person from chronic debilitating postherpetic neuralgia.

There are two types of vaccines, but only one is available in the United States: Shingrix. The Shingrix vaccine is not a live vaccine. It is safe and effective in people with psoriasis and psoriatic arthritis, and it has very few contraindications.

A Word From Verywell

Life can be challenging enough when living with a chronic disease like psoriatic arthritis, but it's important to make efforts to reduce the risk of other illnesses like shingles. Fortunately, there are very few risks associated with shingles vaccination. The Shingrix vaccine is safe and effective in preventing the painful shingles rash that can only worsen your PsA.