Shingles injection and polymyalgia

Oh - and forgot to say, it contains amongst other things, neomycin. If you are allergic to that (and I know there are people in the group who are) it is NOT for you!

Always check the ingredients of such things - I don't know about anyone else but I have developed a few allergies since having PMR.

I've been on pred 10 years and after a recent flare going down very very slow. Currently at 12.5. Two weeks ago asked rheumy about shingles vac and she said not until you are on a very small dose at least 5. So waiting and hoping I can reach that level.  

Have had shingles once since having PMR can i get it again?....think I would be too frightened to have the vaccine....read somewhere recently not to have it if taking Pred...how confusiing as usual!

The documentation I was reading yesterday for my post above suggests that it is very unusual to develop shingles more than once - I presume because the resurgence of the virus in the body triggers the immune response to herpes zoster again which it is thought does fade over time.  That would effectively be a form of vaccination. They have no idea how long the immunity due to the jab lasts either - maybe less than 5 years is suggested. Their position is that under 20mg or short term higher dose pred is OK - but you can be taking pred for illnesses that aren't necessarily due to a dodgy immune system and that would be different.

However,  when you have an autoimmune disorder you are in a totally different place. as to what your immune system is capable of. There is no test I know of that will show if you have developed the particular immune reponse to herpes zoster and presumably the fact that it tends to be older people who develop shingles is because the natural immunity has waned - and that makes the virus able to wake up again. So if you have the vaccine and your immune system is too wonky anyway - is there actually a risk you could develop shingles from the weakened vaccine? I have no idea - and probably neither do the medics.

Thank you Eileen....

Thank you for your reply.  Very informative as usual!  I am 70 and my doctor says she has no information to say that I should not have the vaccination but has left it up to me. Oh dear, I hate these decisions.  Thanks to everyone who replied.

The UK government "Green Book" says:

"The vaccine should not be given to a person who (amongst others):

Is on immunosuppressive or immunomodulating therapy including:

– those who are receiving or have received in the past 6 months immunosuppressive chemotherapy or radiotherapy for malignant disease or non-malignant disorders

– those who are receiving or have received in the past 6 months immunosuppressive therapy for a solid organ transplant (depending upon the type of transplant and the immune status of the patient).

– those who are receiving or have received in the past 12 months biological therapy (e.g. anti-TNF therapy such as alemtuzumab, ofatumumab and rituximab) unless otherwise directed by a specialist

– those who are receiving or have received in the past 3 months immunosuppressive therapy including

i) short term high-dose corticosteroids (>40mg prednisolone per day for more than 1 week);

ii) long term lower dose corticosteroids (>20mg prednisolone per day for more than 14 days)

iii) non-biological oral immune modulating drugs e.g. methotrexate >25mg per week, azathioprine >3.0mg/kg/day or 6-mercaptopurine >1.5mg/kg/day

Many adults with chronic inflammatory diseases (e.g. rheumatoid arthritis, inflammatory bowel disease, psoriasis, glomerulonephritis) may be on stable long term low dose corticosteroid therapy (defined as up to 20mg prednisolone per day for more than 14 days) either alone or in combination with other immunosuppressive drugs including biological and non-biological therapies. Long term stable low dose corticosteroid therapy (defined as up to 20mg prednisolone per day for more than 14 days) either alone or in combination with low dose non-biological oral immune modulating drugs (e.g. methotrexate up to 25mg per week, azathioprine up to 3.0mg/kg/ day or 6-mercaptopurine up to 1.5mg/kg/day) are not considered sufficiently immunosuppressive and these patients can receive the vaccine. Specialist advice should be sought for other treatment regimes.

So it all depends on your history in the last 6 months: you have been on high dose pred at any time in that period, no vaccine. If you are on mtx or azathiorpine above the doses quoted, no vaccine. Otherwise it is said to be no problem.

Hi Eileen. I suspect the age the NHS started vaccinating here in UK, 79 I believe, had more to do with their buget than anything else if what you say is correct. If they had started with say 65 year olds and it wears off after app 5 years, then they would have to re vaccinate! I was offered it when I was 71 but declined until I had more time to look into it. Hey presto, I started with Shingles before I had made a decision! Sod's law or what?

  I've just had blood tests to check for PM but all came back negative and my GP had asked for all relevant tests for this and RA. She concludes that I definitely have OA, Xrays/scans show spine and multi joints including my shoulders and that this is most likely the reason for the stiffness and shoulder pain I have. So..... back to square one! Watch this space.

"all came back negative" - there is no negative or positive test for PMR. You can have PMR and/or GCA without the inflammatory markers being raised at all - happens to about 1 in 6 patients (possibly even more since of course half the time they aren't recognised).

In the meantime - you could try a bit of Bowen therapy and see if it helps the shoulders? Won't do much about PMR itself but it can make other bits far more comfortableif the muscles are less tight.  Very gentle so wouldn't hurt any OA bits.

Hmmm - bad luck about the shingles - hope it was a mild attack.

If your outbreaks of shingles aren't creating an immunity against a further outbreak I'd be very surprised if the vaccine would achieve that. Prevention of furture attacks is still dependent on your immune system being able to do that in response to the vaccine. Your consultant will have to discuss that with an immunologist though.

However - I do hope you are able to find some way of preventing more attacks.