Infections and the risk of incident giant cell arteritis: a population-based, case-control study

Rhee, Rennie L.; Grayson, Peter C.; Merkel, Peter A.; Tómasson, Gunnar

doi:10.1136/annrheumdis-2016-210152

Cited by 54 publications

(53 citation statements)

References 33 publications

(31 reference statements)

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“…More recently, the association between prior infections, in particular herpes zoster, and incident GCA has been studied in a population-based cohort. In this study, the Authors found that antecedent infections were only moderately associated with incident GCA, therefore suggesting that infectious agents are probably a minor determinant of overall risk of GCA [22].…”

Section: Role Of Infectious Agentsmentioning

confidence: 56%

New insights into the pathogenesis of giant cell arteritis

Ciccia

Rizzo

Ferrante

et al. 2017

Autoimmunity Reviews

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Section: Role Of Infectious Agentsmentioning

confidence: 56%

New insights into the pathogenesis of giant cell arteritis

Ciccia

Rizzo

Ferrante

et al. 2017

Autoimmunity Reviews

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“…One prior case–control study that was focused primarily on HZ occurring after GCA diagnosis performed limited comparisons of HZ events preceding GCA and found no association . Another recent study found a small but significantly increased risk of GCA after HZ events as well as infections in general in a population‐based case–control study . In summary, the epidemiologic relationship between HZ events and incident GCA is not fully understood and is yet to be appropriately studied using a cohort design that is necessary for defining the temporal relationship between exposure and disease onset.…”

mentioning

confidence: 99%

Herpes Zoster as a Risk Factor for Incident Giant Cell Arteritis

England

Mikuls

Xie

et al. 2017

Arthritis & Rheumatology

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Objectives Histopathological studies have implicated herpes zoster (HZ) as a causative organism of giant cell arteritis (GCA). We assessed the epidemiologic association of HZ events with incident GCA. Methods We performed a retrospective cohort study utilizing two, large, independent US administrative datasets (Medicare 5% and Truven MarketScan) with eligible subjects having 12 months of continuous coverage, >50 years old, and without history of GCA or polymyalgia rheumatica. HZ events (complicated and uncomplicated) and GCA were identified by ICD-9 codes from physician visits or hospital discharges. Antiviral therapies and vaccinations were identified as prescription claims and drug codes. Risk of incident GCA was calculated using multivariable Cox proportional hazards regression. Results Among 16,686,345 subjects, 5,942 GCA cases occurred with 3.1% (MarketScan) and 6.0% (Medicare) having preceding HZ events. Unadjusted GCA incidence rates were highest in those with complicated and uncomplicated HZ. After multivariable adjustment, complicated HZ was associated with an increased risk of GCA (MarketScan Hazard ratio [HR] 2.16, 95% confidence interval (CI) 1.46–3.18; Medicare HR 1.99, 95% CI 1.32–3.02) as was uncomplicated HZ (MarketScan HR 1.45, 95% CI 1.05–2.01; Medicare HR 1.42, 1.02–1.99). Vaccination and antiviral treatment were not consistently associated with GCA risk, though antivirals were marginally associated with a decreased risk of GCA in Medicare (HR 0.67, 95% CI 0.46–0.99). Conclusions HZ is associated with increased GCA risk. The infrequency of HZ in GCA patients suggests it is only one potential trigger for GCA. Antivirals and vaccination did not consistently mitigate this risk.

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“…We thank Professor Moiseev and colleagues for showing their interest in our work 1 2. While we agree that our study does not completely refute the link between varicella zoster virus (VZV) and giant cell arteritis (GCA), we feel that stronger evidence of a link between VZV and GCA are needed before clinical trials are conducted in which patients with GCA are given antiviral therapy.…”

mentioning

confidence: 72%

Response to eLetter: ‘Infections in giant cell arteritis and therapeutic implications’ by Moiseev et al

et al. 2017

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Response to eLetter: 'Infections in giant cell arteritis and therapeutic implications' by Moiseev et alWe thank Professor Moiseev and colleagues for showing their interest in our work.1 2 While we agree that our study does not completely refute the link between varicella zoster virus (VZV) and giant cell arteritis (GCA), we feel that stronger evidence of a link between VZV and GCA are needed before clinical trials are conducted in which patients with GCA are given antiviral therapy. If VZV, whether clinically overt, subclinical or latent, triggers the onset of GCA, we would have expected a stronger association between herpes zoster and GCA compared with the association of other infections with GCA. Although outside the scope of our study, we agree that the risk of infection following the institution of immunosuppressive therapy, including biological agents, for GCA is extremely important and needs to be further defined.

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Infections and the risk of incident giant cell arteritis: a population-based, case-control study

Cited by 54 publications

References 33 publications

New insights into the pathogenesis of giant cell arteritis

New insights into the pathogenesis of giant cell arteritis

Herpes Zoster as a Risk Factor for Incident Giant Cell Arteritis

Response to eLetter: ‘Infections in giant cell arteritis and therapeutic implications’ by Moiseev et al

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