Herpes zoster in patients with sciatica
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RESEARCH ARTICLE
Open Access
Herpes zoster in patients with sciatica Der-Shin Ke1, Chao-Yu Hsu1,2,3,4,5,6,7, Cheng-Li Lin8,9, Chung-Y. Hsu10 and Chia-Hung Kao10,11,12,13*
Abstract Background: Several diseases are associated with herpes zoster (HZ). However, whether sciatica is a stressor leading to HZ development remains unclear. Here, we evaluated the occurrence of HZ in patients with sciatica. Methods: The sciatica cohort consisted of patients first diagnosed as having sciatica between 2000 and 2012. All patients with sciatica were randomly age, sex and index year matched with control individuals without sciatica. The primary outcome was diagnosis of HZ. All individuals were followed until HZ diagnosis, withdrawal from the insurance, death, or December 31, 2013, whichever occurred first. HZ risk in the two cohorts was further analyzed with age, sex and comorbidity stratification. Results: In total, 49,023 patients with sciatica and 49,023 matched controls were included. Female patients were more likely to have HZ development than were male patients [adjusted hazard ratio (HR) = 1.07, 95% confidence interval (CI) = 1.02–1.12]. After adjustments for all the covariates, HZ risk was significantly higher in the sciatica cohort than in the control cohort (adjusted HR = 1.19; 95% CI = 1.12–1.25). Conclusion: Sciatica increased HZ risk. Thus, HZ risk should be addressed whenever physicians encounter patients with sciatica, HZ vaccination should be considered especially those aged over 50. Keywords: Sciatica, Herpes zoster, Depression, Obesity
Background Sciatica is characterized by a burning sensation or shooting pain caused by irritation or compression of the sciatic nerve, and the most common cause of sciatica is spinal disc herniation. Sciatica prevalence and incidence rates have been reported to be 1.2–43% and 1–37%, respectively; the large variations may be due to the differences in definitions or study population in the concerned studies [1, 2]. Sciatica treatment intensity is dependent on disease severity, and the treatment can include exercise, manual therapy, medication, spinal injection and surgery [3]. Herpes zoster (HZ), a painful vesicular eruption, occurs due to varicella-zoster virus (VZV) reactivation. * Correspondence: [email protected]; [email protected] 10 Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, No. 2, Yuh-Der Road, Taichung 404, Taiwan 11 Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan Full list of author information is available at the end of the article
HZ incidence was 9.92 per 1000 person-years in immunocompetent, unvaccinated adults aged ≥50 years, with a case-fatality rate of 0.04% [4]. HZ incidence can be high after transplantation. Kim et al. reported that HZ incidence after liver transplantation in adults was 16.3 per 1000 person-years. HZ incidence was 9.1, 10.0, and 11.9% at 3, 5, and 10 years after transplantation, respectively [5]. Postherpetic neur
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