title: ARIZONA study: is the risk of post-herpetic neuralgia and its burden increased in the most elderly patients?
abstract: BACKGROUND
  In a context of change in the demographic profile of the older population, to identify an age threshold for increased risk and burden of herpes zoster (HZ) in 70+ patients.
  
  
  METHODS
  Post hoc analysis of the 12-month French nationwide prospective observational ARIZONA cohort study. HZ was assessed by means of the following validated questionnaires: Neuropathic Pain Symptom Inventory (NPSI), Zoster Brief Pain Inventory (ZBPI), Short-Form health survey (SF-12), and Hospital Anxiety and Depression Scale (HADS).
  
  
  RESULTS
  644 general practitioners included 1,358 volunteer patients with acute HZ in the ARIZONA study; 609 patients (45%) were 70+. In 70+ patients, age did not increase rash severity or HZ-related pain intensity at diagnosis, but increased by 64% the frequency of ophthalmic zoster (from 5.5% in 70-74 years age-group to 9.0% in 85+ patients, p = NS). Age was significantly associated with low physical health as assessed by the SF-12 Physical Component Summary (SF-12 PCS) score and bad mood as assessed by the HADS depression score (p < 0.001). Within the year following HZ, post-herpetic neuralgia (PHN) was systematically but not significantly more frequent in 85+ patients than in the 70-74, 75-79, or 80-84 years age-groups (19.0% vs. 13.3%/15.3%/11.6% at month 3; 15.1% vs. 7.3%/11.0%/12.2% at month 6; 15.2% vs. 6.0%/8.0%/6.0% at month12, respectively). SF-12 PCS and HADS depression scores improved from day 0 to month 12 in all patients (p < 0.001). 85+ patients were more impaired than younger patients (p < 0.001), but without clear difference according to PHN.
  
  
  CONCLUSIONS
  This study did not show in 70+ patients a clear and significant age threshold at which disease burden increased, although for some domains the impact seemed higher among the oldest patients; the cut-off of 70 years remains thus relevant for clinical and epidemiological studies. However, at individual level, assessment of the burden of HZ and HZ-related pain appears necessary to improve management and prevent functional decline in the most vulnerable 70+ patients.
authors.affiliation: Paris-Diderot University Sorbonne Paris Cité, EA 7334 REMES, Patient-Reported Outcomes Unit, 75010 Paris, France. duracinsky.m@gmail.com.
authors.forename: Martin
authors.initials: M
authors.lastname: Duracinsky
authors.forename: Marc
authors.initials: M
authors.lastname: Paccalin
authors.forename: Gaëtan
authors.initials: G
authors.lastname: Gavazzi
authors.forename: Sohéla
authors.initials: S
authors.lastname: El Kebir
authors.forename: Jacques
authors.initials: J
authors.lastname: Gaillat
authors.forename: Christophe
authors.initials: C
authors.lastname: Strady
authors.forename: Didier
authors.initials: D
authors.lastname: Bouhassira
authors.forename: Olivier
authors.initials: O
authors.lastname: Chassany
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005602:France / Q000453:epidemiology; D006562:Herpes Zoster / Q000150:complications / Q000453:epidemiology; D006801:Humans; D008297:Male; D051474:Neuralgia, Postherpetic / Q000453:epidemiology* / Q000209:etiology; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires