Does herpes zoster predispose to giant cell arteritis: a geo-epidemiologic study

Abstract

PurposeGiant cell arteritis (GCA) is the most common systemic vasculitis in the elderly and can cause irreversible blindness and aortitis. Varicella zoster (VZ), which is potentially preventable by vaccination, has been proposed as a possible immune trigger for GCA, but this is controversial. The incidence of GCA varies widely by country. If VZ virus contributes to the immunopathogenesis of GCA we hypothesized that nations with increased incidence of GCA would also have increased incidence of herpes zoster (HZ). We conducted an ecologic analysis to determine the relationship between the incidence of HZ and GCA in different countries.MethodsA literature search for the incidence rates (IRs) of GCA and HZ from different countries was conducted. Correlation and linear regression was performed comparing the disease IR of each country for subjects 50 years of age or older.ResultsWe found the IR for GCA and HZ from 14 countries. Comparing the IRs for GCA and HZ in 50-year-olds, the Pearson product-moment correlation (r) was −0.51, with linear regression coefficient (β) −2.92 (95% CI −5.41, −0.43; p=0.025) using robust standard errors. Comparing the IRs for GCA and HZ in 70-year-olds, r was −0.40, with β −1.78, which was not statistically significant (95% CI −4.10, 0.53; p=0.12).ConclusionAlthough this geo-epidemiologic study has potential for aggregation and selection biases, there was no positive biologic gradient between the incidence of clinically evident HZ and GCA.

Varicella Zoster Virus in Giant Cell Arteritis: A Review of Current Medical Literature

“…However, these authors reached a similar conclusion as we do, that there is insufficient evidence to support a direct causation theory. 32 We are in agreement with these authors, that until future investigations can consistently support a role for VZV in GCA, treatment for VZV in patients with GCA would not be supported by the evidence found in current medical literature.…”

“…31 Additionally, epidemiological data has not supported a relationship between the incidence of GCA and VZV reactivation in newly diagnosed GCA amongst patients previously immunised against VZV, compared with nonimmunised patients. 32 One study in Israel reported a GCA mean incidence of 41.6/100,000/year, varying between 40.9 and 46.7 non-immunised patients per 100,000 per year. For patients previously immunised against VZV, the mean incidence of GCA was 75.2/100,000 in immunised patients.…”

<p>Neural network and logistic regression diagnostic prediction models for giant cell arteritis: development and validation</p>

“…Although classification criteria for GCA exist, diagnostic criteria confirmed by large studies are pending. The NN and LR models are subject to misclassification error because of the overlapping symptoms and signs that GCA shares with other diseases, including primary HA syndrome, other autoimmune diseases,39 infection, polymyalgia, fibromyalgia, amyloidosis,40 herpes zoster,41 and NAION 10. In addition, we did not document the final diagnoses of the patients from the 14 centers, and we did not consider variables such as PMR and race for reasons outlined in the “Methods” section.…”

Systematic Review of the Yield of Temporal Artery Biopsy for Suspected Giant Cell Arteritis

“…Although some feel that a high ACR risk score may obviate TAB, 14 we advocate confirmatory TAB given the risks of systemic glucocorticoid treatment, and because other diseases can mimic or overlap the clinical presentation of GCA, including amyloidosis, 21 granulomatosis with polyangiitis and other antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides, 22 calciphylaxis, 23 Mönckeberg's medial calcific sclerosis, 24 and zoster sine herpete. 25 Without TAB, these alternative diagnoses may not be determined in an expedient fashion.…”