Nearly all adults have been af­fected by mono

Cape Breton Post - - TV HIGHLIGHTS/LIFESTYLES - Keith Roach

DEAR DR. ROACH: Can ex­po­sure to in­fec­tious mononu­cle­o­sis trig­ger or cause rheuma­toid arthri­tis to flare up and be­come ac­tive? I would ap­pre­ci­ate your com­ments. Thank you. — J.C.

AN­SWER: The Ep­stein-Barr virus — the cause of in­fec­tious mononu­cle­o­sis (although there are other germs that can cause a sim­i­lar pic­ture) — has been as­so­ci­ated with rheuma­toid arthri­tis, and there is some ev­i­dence that EBV may be a trig­ger that causes RA and pos­si­bly other au­toim­mune dis­eases, such as lu­pus, to be­come ac­tive in a per­son who is ge­net­i­cally sus­cep­ti­ble. How­ever, this ev­i­dence is only spec­u­la­tive at this point, since an al­ter­na­tive ex­pla­na­tion for the as­so­ci­a­tion is that the im­mune de­fi­cien­cies in RA and other au­toim­mune dis­eases al­low for ab­nor­mal per­sis­tent repli­ca­tion of EBV.

What is more im­por­tant is that nearly all adults (90-95 per­cent) have had EBV in­fec­tion, and re-ex­po­sure to the virus does not cause clin­i­cal in­fec­tion and al­most cer­tainly will not trig­ger new on­set or a flare-up of RA in peo­ple who al­ready have been ex­posed to EBV.

DEAR DR. ROACH: I have never had the shin­gles, nor even chickenpox. I couldn't find a record of it, even in my baby book. Do I need to have the shin­gles shot? I am over 70 and take sev­eral med­i­ca­tions for high blood pres­sure and choles­terol. — C.S.

AN­SWER: I rec­om­mend the shin­gles vac­cine to some­one in your sit­u­a­tion, de­spite the fact that the shin­gles vac­cine isn't per­fect. In the ini­tial trial that got the vac­cine ap­proved, fol­low­ing al­most 40,000 adults over 60, 3.3 per­cent who did not re­ceive the vac­cine got shin­gles in three years, and 1.6 per­cent of those who re­ceived the vac­cine de­vel­oped shin­gles. How­ever, for the dreaded com­pli­ca­tion of post-her­petic neu­ral­gia, hav­ing the vac­cine re­duced the risk from 0.6 per­cent to 0.2 per­cent in peo­ple over 70.

Most peo­ple over 70 have had chickenpox. Some­times the dis­ease is so mild that it can go un­rec­og­nized. But both peo­ple who have and have not had chickenpox should get the vac­cine. Peo­ple with con­di­tions weak­en­ing their im­mune sys­tem should not get the vac­cine.

The ab­so­lute ben­e­fits of 1.7 per­cent re­duc­tion in de­vel­op­ing shin­gles, plus the 0.4 per­cent re­duc­tion in post-her­petic neu­ral­gia are not very large. About 50 peo­ple would need to be vac­ci­nated to pre­vent one bad out­come in three years. Over a long time, how­ever, the ab­so­lute ben­e­fit is likely to get more im­pres­sive.

More im­por­tantly, the risk of the vac­cine is small. The ma­jor ad­verse events have been headache and sore arm. In my opin­ion, the ben­e­fits far out­weigh the risks, and by vac­ci­nat- ing a lot of peo­ple, some cases of shin­gles and post-her­petic neu­ral­gia can be pre­vented. Hav­ing seen how dev­as­tat­ing post-her­petic neu­ral­gia can be in an older per­son, I think it is worth it.

DEAR DR. ROACH: In your re­cent col­umn on Achilles tendinopa­thy, you dis­cuss treat­ment, but please also make sure that the pa­tient does not have a spondy­loarthropa­thy. — Dr. Irene Blanco, M.D.

AN­SWER: The spondy­loarthropathies are a group of re­lated con­di­tions, in­clud­ing anky­los­ing spondyli­tis, pso­ri­atic arthri­tis and re­ac­tive arthri­tis ( for­merly called Reiter's syn­drome). These all in­crease the risk of Achilles tendinopa­thy, due to in­flam­ma­tion at the in­ser­tion of ten­dons to bone. Sim­i­larly, these con­di­tions also in­crease the risk of plan­tar fasci­itis. Achilles tendinopa­thy and re­cur­rent plan­tar fasci­itis should prompt your doc­tor to con­sider the pos­si­bil­ity of one of the spondy­loarthropathies. X-rays and blood tests help con­firm the clin­i­cal di­ag­no­sis.

I thank Dr. Blanco for writ­ing.

Dr. Roach re­grets that he is un­able to an­swer in­di­vid­ual letters, but will in­corpo

rate them in the col­umn when­ever pos­si­ble. Read­ers may email ques­tions to ToYourGoodHealth@med.cor­nell.edu or re­quest an or­der form of avail­able health news­let­ters at P.O. Box 536475, Or­lando, FL 32853-6475. Health news­let­ters may be or­dered from www.rb­ma­mall.com. (c) 2015 North Amer­ica Syn­di­cate Inc. All

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