Department of Rheumatology, Sahlgrenska University Hospital, Göteborg, Sweden. email@example.com
Giant cell arteritis (GCA) is reported world-wide. However, the incidence varies greatly in different geographic regions with the highest incidence rates from Scandinavian countries and North American populations of the same descent. The etiopathogenesis of GCA is incompletely understood. Although data on a positive correlation between the occurrence of infection and the onset of GCA as well as rhythmic fluctuations in disease incidence have been reported, no statistically significant periodicity has so far been found regarding the annual incidence of GCA. Seasonal variations may indicate a role of infection or other environmental factors in the pathogenesis of GCA.
Sandro Gelsomino, Stefano Romagnoli, Franca Gori, Gabriella Nesi, Chiara Anichini, Carlo Sorbara, Pierluigi Stefàno, Gian Franco Gensini
Department of Cardiac Surgery, Careggi Hospital, Florence, Italy. firstname.lastname@example.org
BACKGROUND: Thoracic aortic aneurysm, aortic dissection and aortic valve regurgitation have been widely described in patients with Horton disease, also known as giant cell arteritis. We present our midterm experience with patients with these features. METHODS: A total of 386 cases of ascending aorta and aortic valve replacement performed for thoracic aortic aneurysm and aortic insufficiency between 1998 and 2004 were reviewed. Among them 10 cases of histopathologically confirmed GAA were identified. Patients were predominantly female (90%); the mean age was 74.5 +/- 4.6 years. RESULTS: Eight patients (80%) showed typical annuloaortic ectasia, leading to significant aortic valve regurgitation. These subjects underwent a Bentall operation. Two patients whose sinuses seemed undilated and macroscopically normal had separate valve graft replacement at first operation and underwent reoperation due to dilatation of the native sinuses. Eight patients had partial aortic arch replacement (hemiarch), and 1 underwent total arch replacement. Six-year survival was 0.9 +/- 0.09; freedom from reoperation at 6 years was 0.77 +/- 0.13. CONCLUSIONS: Annuloaortic ectasia is a common finding in giant cell arteritis. In patients with Horton disease, the aortic root should always be replaced regardless of macroscopic findings.
Human parvovirus B19, varicella zoster virus, and human herpes virus 6 in temporal artery biopsy specimens of patients with giant cell arteritis: analysis with quantitative real time polymerase chain reaction.
R Alvarez-Lafuente, B Fernández-Gutiérrez, J A Jover, E Júdez, E Loza, D Clemente, J A García-Asenjo, J R Lamas
Rheumatology Service, Hospital Clínico San Carlos, Madrid, Spain.
OBJECTIVE: To evaluate the role of parvovirus B19 (B19), varicella zoster virus (VZV), and human herpes virus 6 (HHV-6) in the aetiopathology of giant cell arteritis (GCA). METHODS: Temporal artery biopsy specimens from 57 patients with GCA and 56 controls were investigated. DNA was obtained by biopsy, and quantitative real time polymerase chain reaction assay performed to establish the prevalence and viral load of B19, VZV, and HHV-6. Amplification of the human beta-globin gene was used as internal positive control. RESULTS:(a) B19 was detected in 31/57 (54%) patients (median viral load 45.2 (25th-75th centiles 0-180.2) copies/microg DNA) v 21/56 (38%) controls (median viral load 0 (0-66.7) copies/microg of DNA; p = 0.07 for DNA prevalence, p = 0.007 for viral load. Among 31 B19 positive samples, 21 (68%) patients with biopsy proven GCA had >10(2) B19 copies/microg of DNA v 5/21 (24%) controls; p = 0.001.(b) No significant difference was found for VZV (p = 0.94 for DNA prevalence; p = 0.76 for viral load) and HHV-6 (p = 0.89 for DNA prevalence; p = 0.64 for viral load) in the GCA group compared with controls. CONCLUSION: B19 may have a role in the aetiopathology of GCA, particularly in those patients with high viral load; no evidence was found for VZV and HHV-6.
Dipartimento Osteo-Articolarem, Cattedra e UOC di Genetica Medica, Università degli Studi di Parma, Italy.
The ethnic and geographic prevalence, the familial aggregation, and the reported association with some HLA class II antigens of both giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) strongly suggest the role of genetic factors in the pathogenesis of these diseases. We describe the familial aggregation of GCA and PMR in 2 unrelated families from Northern Italy. In the first family, 2 sisters developed GCA a few months apart. In the second, one sister had GCA, and 2 years later her siblings developed PMR nearly simultaneously. Patients with GCA in the first family shared the whole HLA genotype (A*24,*26, B*38,*55, DRB1*11,*14, DQB1*05,*07, DRB3*). In the second family, both PMR siblings carried the A*68, B*44, DRB1*11, DQB1*07, DRB3* alleles. Thus all patients of both families shared DRB1*11, DQB1*07, and DRB3*. Predisposing immunogenetic factors of both GCA and PMR are discussed.
No evidence of parvovirus B19, Chlamydia pneumoniae or human herpes virus infection in temporal artery biopsies in patients with giant cell arteritis.
Department of Infectious Diseases, Hvidovre University Hospital, Denmark.
OBJECTIVES Recent studies have suggested that infective agents may be involved in the pathogenesis of giant cell arteritis (GCA), in particular Chlamydia pneumoniae and parvovirus B19. We investigated temporal arteries from patients with GCA for these infections as well as human herpes viruses using the polymerase chain reaction (PCR). METHODS Thirty temporal artery biopsies from 30 patients suspected of having GCA within a period of 1 yr were examined. Thirteen patients had classical GCA, two had biopsy-negative GCA, 10 patients had polymyalgia rheumatica and five patients had other conditions. DNA was extracted from frozen biopsies and PCR was used to amplify genes from Chlamydia pneumoniae, parvovirus B19 and each of the eight human herpes viruses: herpes simplex viruses HSV-1 and 2, Epstein-Barr virus, cytomegalovirus, varicella zoster virus and human herpes viruses HHV-6,-7 and -8. RESULTS In all 30 biopsies, PCR was negative for DNAs of parvovirus B19, each of the eight human herpes viruses and C. pneumoniae. CONCLUSIONS We found no evidence of DNA from parvovirus B19, human herpes virus or C. pneumoniae in any of the temporal arteries. These agents do not seem to play a unique or dominant role in the pathogenesis of GCA.
Department of Internal Medicine/Division of Nephrology, University Hospital Groningen, Faculty of Medical Sciences, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands. C.A.Stegeman@int.azg.nl
Clinic of Rheumatology, DI.M.I., University of Genoa, Italy. email@example.com
OBJECTIVE To review the data on the epidemiology of polymyalgia rheumatica (PMR), in particular geographical and temporal differences in incidence and its risk factors including the actinic hypothesis. METHODS Evaluation of the literature. RESULTS Epidemiological data show that the incidence of PMR varies between 12.7/100,000 in Italy and 112.6/100,000 in Norway with a geographical gradient of increased frequency in the northern hemisphere. The incidence of PMR and giant cell arteritis (GCA) have increased in recent years. This observation may be related to a greater awareness of the disease but also to real epidemiological changes. Risk factors for PMR/GCA include infections, smoking, sun exposure, and nulliparity. CONCLUSION Epidemiological studies have helped to unravel the etiopathogenic factors at work in PMR/GCA. More data are needed on the correlation between the incidence of PMR/GCA and epidemics of infectious diseases and on environmental and biological risk factors.
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Scand J Rheumatol. 2009 Jan 28;:1-5 19177264
Expression of the class I interferon-related MxA protein in temporal arteries in polymyalgia rheumatica and temporal arteritis.
Departments of Pathology.
Objective: The aim of this study was to assess the expression of the interferon type I (IFN-I)-associated MxA protein in polymyalgia rheumatica (PMR) and temporal arteritis (TA). Methods: Non-inflamed temporal artery biopsies from 11 PMR patients were compared with biopsies from 13 patients given other diagnoses. Coded sections were screened immunocytochemically for MxA protein, CD83, CD68, CD3, and S100 protein. Inflamed temporal artery biopsies from four patients with TA were also investigated. Results: Focal MxA expression was seen in non-inflamed arteries, more frequently in PMR than in controls (p = 0.0124). MxA expression was also more common in adventitial dendritic cells (DCs) in PMR (p = 0.0124). Activated adventitial DCs were detected in PMR. Focal MxA expression in the inflamed biopsies from the patients with TA was not related spatially to the inflammation. Conclusions: The expression of MxA protein in arteries from patients with PMR and TA shows that non-inflamed and inflamed vessel walls are influenced by IFN-I. Further studies are required to elucidate whether IFN-I plays a role in the initiation of PMR and/or TA, serving as a link between the innate and the adaptive immune responses, as in some other autoimmune disorders.
An Uneven Expression of T Cell Receptor V Genes in the Arterial Wall and Peripheral Blood in Giant Cell Arteritis.
Department of Rheumatology, Sahlgrenska University Hospital, 413 45, Göteborg, Sweden.
The aim of the study was to investigate T cell receptor (TCR) usage at the time of diagnosis of giant cell arteritis (GCA) and to estimate the degree of clonality of T-cells infiltrating the lesion. Seven patients with biopsy-proven giant cell arteritis were included in the study. Immunocytochemistry in biopsies from the temporal arteries and flow cytometric analysis of peripheral blood lymphocytes (PBL) was performed using monoclonal antibodies specific for CD3, CD4 and CD8 and 13 TCR Valpha and Vbeta gene segment products. The CDR3 fragment length polymorphism was assessed by gel electrophoresis of PCR-amplified TCR segments. The T lymphocytes were found to be concentrated to the adventitia rather than the media or intima. Six of the seven patients with GCA had expansions of T lymphocytes, expressing selected TCR V genes in the arterial wall. None of these expansions was found in PBL. The infiltrating T-cells were poly- or oligoclonal. In conclusion, the dominating part of the inflammatory infiltrate in GCA emanates from the adventitial microvessels. There is an uneven expression of TCR V genes by T lymphocytes in the inflammatory infiltrates as compared to peripheral blood T lymphocytes at the time of diagnosis, consistent with an antigen-driven immunological reaction in the arterial wall.
Comparison of soluble ICAM-1, VCAM-1 and E-selectin levels in patients with episodic cluster headache and giant cell arteritis.
The pathophysiology of cluster headache (CH) is supposed to involve the lower posterior part of the hypothalamus, the trigeminal nerve, autonomic nerves and vessels in the orbital/retro-orbital region. The exact connection of this hypothalamic-trigemino-autonomic-vascular axis is not fully understood. The presence of inflammation in the perivascular tissue of the retro-orbital region has been presented as a possible mechanism behind the pain and the sympatheticoplegia sometimes observed during headache attacks. In a previous study we found neither increased levels of erythrocyte sedimentation rate, C-reactive protein or acute-phase reactants nor clinical signs of a generalized inflammatory disorder. However, these tests may not be sensitive enough to detect a focal inflammatory process in the retro-orbital region. In the present study, we analysed serum levels of three soluble adhesion molecules; soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1) and soluble E-selectin (sE-selectin) in patients with episodic CH and in patients with biopsy-positive giant cell arteritis (GCA), a known vasculitic disorder of large and medium-sized arteries. A control group of healthy volunteers was also included. Within the CH group, sICAM-1, sVCAM-1 and sE-selectin showed an increasing trend in remission compared with the active CH period, but the difference was statistically significant for sE-selectin only. The mean sICAM-1 value was higher in patients with active GCA than in CH patients during the active cluster period. Compared with the healthy control group, the mean levels of soluble adhesion molecules in CH patients also tended to be higher, but statistically significantly so only for sVCAM-1. We hypothesize that CH is not a vasculitic disorder of the medium-sized arteries, but CH patients may have an immune response that reacts differently from that of healthy volunteers.
Departments of Rheumatology, Sahlgrenska University Hospital, Göteborg.
A Western blot and molecular genetic investigation of the estrogen receptor beta in giant cell arteritis.
Department of Rheumatology, Sahlgrenska University Hospital, Göteborg, Sweden.
OBJECTIVE:The epidemiology of giant cell arteritis (GCA) may indicate a pathogenetic relationship between GCA and female sex hormone metabolism; GCA is two to four times more common in women compared with men. Our previous analyses gave no support for the hypothesis that the pathogenesis of GCA should be related to somatic mutations in the estrogen receptor alpha (ERalpha) gene. The object of the present study was to investigate the size of the estrogen receptor beta (ERBeta), and the size and nucleotide sequence of the ERBeta gene in temporal arteries in GCA.METHODS:The ERBeta protein was analyzed by Western blot technique and the ERBeta gene by RT-PCR and direct sequencing of the PCR product.RESULTS:Western blot analysis revealed an ERBetaof normal size. There were no aberrations in size or nucleotide sequence in the ERBeta gene in the GCA patients. CONCLUSION:The present observations gave no support for the hypothesis that somatic mutations in the ERBeta gene should be involved in the pathogenesis of GCA.
Difficulties in the development of histological scoring of the inflamed temporal arteries in giant cell arteritis.
APMIS. 2005 Sep ;113 (9):594-9 16218934
Department of Pathology, Sahlgrenska University Hospital, Göteberg, Sweden.
The aim of the present study was to investigate the expression of TP53 (p53) and CDKN1A (CIP1; p21) in the arterial wall in giant cell arteritis (GCA). Cross-sections from 18 temporal artery biopsies displaying GCA and 8 control arteries were double-stained with monoclonal antibody directed at p53 or p21 on the one hand and alpha-smooth muscle actin, CD68 (macrophage) or CD3 (T-cell) on the other. Nuclear p53 was expressed in CD68-positive cells and smooth muscle cells in 16 of the 18 inflamed arteries. P21-positive nuclei were found in CD68-positive cells in 14 biopsies and in smooth muscle cells in all the specimens. All p53-positive giant cells also contained p21-positive nuclei. In the giant cells, immunopositive nuclei were mixed with negative ones. CD3-positive T-cells did not express p53 or p21. Only one p53-positive smooth muscle cell nucleus was found in the non-GCA controls and, compared with GCA, p21 expression was noted in few smooth muscle nuclei. The presence of p53 and p21 in the same types of cell in GCA indicates that the former protein is functional; p21 expression is induced by wild-type, functional p53 but not by its mutant form. The current observations suggest cellular stress in GCA, the nature of which requires further investigation.
Radiographic joint destruction in postmenopausal rheumatoid arthritis is strongly associated with generalised osteoporosis.
H Forsblad D'Elia, A Larsen, E Waltbrand, G Kvist, D Mellström, T Saxne, C Ohlsson, E Nordborg, H Carlsten
Department of Rheumatology and Inflammation Research, Göteborg University, Sweden. firstname.lastname@example.org
OBJECTIVES: To investigate determinants of joint destruction and reduced bone mineral density (BMD) in postmenopausal women with active rheumatoid arthritis (RA) not treated with bisphosphonates or hormone replacement therapy and to evaluate if there are common markers of erosive disease and bone loss. METHODS: BMD was measured using dual x ray absorptiometry and joint damage was examined by x ray examination according to the Larsen method in 88 patients with RA. Associations between BMD and Larsen score, and between demographic and disease related variables, including proinflammatory cytokines, HLA-DR4 epitopes, and markers of bone and cartilage turnover, were examined bivariately by simple and multiple linear regression analyses. RESULTS: 49/88 (56%) patients had osteoporosis in at least one site. Reduced BMD and increased joint destruction were associated with: at the forearm and femoral neck, high Larsen score, low weight, and old age (R(2)=0.381, p<0.001; R(2)=0.372, p<0.001, respectively); at the total hip, low weight, high Larsen score, and dose of injected glucocorticosteroids (R(2)=0.435, p<0.001); at the lumbar spine, low weight, reduced cartilage oligomeric matrix protein, and increased carboxyterminal propeptide of type I procollagen (R(2)=0.248, p<0.001). Larsen score was associated with long disease duration and increased C reactive protein (CRP)(R(2)=0.545, p<0.001). CONCLUSIONS: Osteoporosis is common in postmenopausal patients with RA. Low weight and high Larsen score were strongly associated with BMD reduction. Increased CRP and long disease duration were determinants of erosive disease in postmenopausal women with RA. These findings indicate common mechanisms of local and generalised bone loss in RA.
The epidemiology of biopsy-positive giant cell arteritis: special reference to changes in the age of the population.
Department of Clinical Pathology, Sahlgrenska University Hospital, Göteborg, Sweden. email@example.com
OBJECTIVE: The incidence of giant cell arteritis (GCA) increases with age. The aim of the present study was to investigate whether the increasing incidence of biopsy-proven GCA in Göteborg, Sweden, could be explained in terms of a change in the age composition of the general population. METHODS: All cases of biopsy-verified GCA between 1976 and 1995 were recorded. The annual incidence was calculated for women and men aged 50 yr or older and its relationship with the age composition of the general population was tested statistically. RESULTS: There was a significant positive correlation between age and the risk of developing GCA. In the general population, there was a shift towards higher age; in 1976, the mean age of people 50 yr or older was 63.2 (men) and 65.0 (women), whereas in 1995 it was 65.0 (men) and 68.1 (women). After compensating for this, the incidence of biopsy-proven GCA still increased significantly. Moreover, for women aged 50 yr or older, the risk of developing the disease increased more among younger subjects than older ones. CONCLUSIONS: The increase in the incidence of biopsy-proven GCA between 1976 and 1995 could not be explained merely in terms of the increasing age of the general population. It is most probably related to an increase in the influence of other factors.
Department of Rheumatology, Sahlgrenska University Hospital, SE-413 45, Göteborg, Sweden. firstname.lastname@example.org
Giant cell arteritis (GCA) is a chronic systemic vasculitis with a marked female predominance and restriction to old age. The disease process distinctly targets large and medium sized arteries, preferentially the aorta and its extracranial branches. Morphological observations indicate that the age and sex distribution of GCA is related to the occurrence of degenerative changes in the arterial wall. GCA is not a truly infectious vasculitis. However, an infection might be a triggering factor. Different centres report an increase in GCA incidence, but annual fluctuations have not been shown to be statistically significant. However, significant seasonal variations have been observed by several groups. The mortality is not increased in adequately treated patients. Although, alternative steroid-sparing agents have been proposed, corticosteroids are still the first treatment choice.
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Eur J Neurol. 2012 Apr ;19 (4):660-2 21972914
Monthly variation of multiple sclerosis activity in the southern hemisphere: analysis from 996 relapses in Brazil.
Department of Neurology, University of Campinas, Campinas, Brazil. email@example.com
BACKGROUND AND PURPOSE Seasonal variations of multiple sclerosis (MS) activity have been reported, however, most data come from studies in the northern hemisphere. METHODS We reviewed medical records of MS patients living in Campinas region, Brazil. The first symptoms' date was defined as the relapse month. Climatic information included UV radiation index, median temperature, rainfall, and humidity. RESULTS Two hundred and nine patients were included. The incidence of relapses was highest in January (11.2%) and December (10.4%) and lowest in November (5.7%) and October (7.0%)(P < 0.015). The months with highest incidence of relapses (December-January) had higher UV radiation index and humidity rates (P = 0.032 and 0.040, respectively). CONCLUSION Most exacerbations were in the spring/summer transition, which also showed higher UV radiation index and humidity rate. Along with other environmental factors, seasonal fluctuation contributes to MS activity.
J Rheumatol. 2010 Mar 15;: 20231195
Lack of Association Between the rs6920220 (G/A) Polymorphism of the 6q23 Region and Biopsy-proven Giant Cell Arteritis.
Rogelio Palomino-Morales, Orlando Torres, Tomas R Vazquez-Rodriguez, Santos Castañeda, Inmaculada C Morado, Jose A Miranda-Filloy, Encarnacion Amigo-Diaz, Jose L Callejas-Rubio, Benjamin Fernandez-Gutierrez, Javier Martin, Miguel A Gonzalez-Gay
From the Instituto de Parasitología y Biomedicina López Neyra, Consejo Superior de Investigaciones Cientificas (CSIC), and the Hospital Clínico San Cecílio, Granada; Division of Rheumatology, Hospital Xeral-Calde, Lugo; Department of Rheumatology, Hospital de la Princesa, Universidad Autónoma, and the Rheumatology Service, Hospital Clínico San Carlos, Madrid; and Division of Rheumatology, Hospital Universitario Marques de Valdecilla, Santander (Cantabria), Spain.
OBJECTIVE: Recently, 2 independent studies have identified an association between several single-nucleotide polymorphisms (SNP) located in the 6q23 chromosomal region and rheumatoid arthritis (RA). Like RA, giant cell arteritis (GCA) is also a complex polygenic disease in which more than 1 genetic locus is likely to contribute to disease susceptibility and clinical expression. We analyzed the involvement of the rs6920220 (G/A) polymorphism from the 6q23/TNFAIP3 gene region in susceptibility to GCA. METHODS: Two hundred twenty patients with biopsy-proven GCA and 490 matched controls were assessed. DNA from patients and controls was obtained from peripheral blood. Samples were genotyped for the 6q23 region rs6920220 using a TaqMan allele discrimination assay and by polymerase chain reaction (PCR) amplification. After PCR, the genotype of each sample was attributed automatically by allelic-specific fluorescence using the ABI Prism 7900 sequence detection system. RESULTS: No significant differences in the genotype distribution between patients with GCA and controls for the rs6920220 (G/A) polymorphism were found. No significant differences were observed when patients with GCA were stratified according to the presence of specific clinical features of the disease such as polymyalgia rheumatica or severe ischemic manifestations or specific visual ischemic complications. CONCLUSION: Our results show no involvement of this 6q23/TNFAIP3 gene region SNP in the susceptibility to or clinical expression of GCA.
Clin Exp Rheumatol. ;27 (5):830-833 19917168
Giant cell arteritis and polymyalgia rheumatica in northwestern Turkey: Clinical features and epidemiological data.
Departments of Rheumatology, Trakya University Medical Faculty, Edirne, Turkey.
OBJECTIVE:In this study, we evaluated clinical and epidemiologic features of our giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) patients.METHODS:We retrospectively recorded down the general features of patients with GCA and PMR diagnosed at our center within the last 6 years. The incidence rates per 100000 aged >/=50 were calculated. In addition, we reported the frequencies of GCA/PMR in our previous epidemiologic study. RESULTS:Nineteen patients were diagnosed with GCA (10F, 9M) and 53 with isolated PMR (39F, 14M). The annual incidence for GCA in subjects >/=50 years old was 1.13/100000, and for PMR it was 3.15/100000. The incidence of GCA and PMR in females were, respectively, 1.14/100000 and 4.48/100000. In males, the incidences of GCA and PMR were, respectively, calculated as 1.1/100000 and 1.72/100000. In our population-based study, the prevalences of GCA and PMR (>/=50 ages) were estimated as 20/100000. Fourteen (73.7%) GCA patients had symptoms of PMR. Two patients had developed unilateral and one patient bilateral permanent visual loss. Initial ESR was lower than 40 mm/hr in one GCA patient (5.3%) and in 6 PMR patients (11.3%). The median duration of follow-up was 16 months in GCA; and 8 months in PMR patients. One patient with PMR and another patient with GCA had lung cancer. One PMR patient had myelodysplastic syndrome. During follow-up, 4 patients with GCA died.CONCLUSION:We detected a lower frequency of GCA/PMR in our center in northwestern Turkey than in Scandinavian and southern European countries.
No correlation between giant cell arteritis and Chlamydia pneumoniae infection: investigation of 189 patients by standard and improved PCR methods.
Florence Njau, Thomas Ness, Ulrike Wittkop, Thorsten Pancratz, Meike Eickhoff, Alan P Hudson, Hermann Haller, Annette D Wagner
Department of Internal Medicine, Division of Nephrology, Hannover Medical School, Carl Neuberg Strasse 1, 30625 Hannover, Germany. firstname.lastname@example.org
A total of 189 temporal artery biopsy samples from giant cell arteritis (GCA) patients were investigated using sensitive PCR targeting Chlamydia pneumoniae. Chlamydial DNA was detected in 17 samples, 11 of which were positive for chlamydial antigens. Our data did not reveal strong evidence that C. pneumoniae plays an important role in the pathogenesis of GCA.
Department of Internal Medicine, School of Medicine, University of California at Davis, Davis, CA 95616, USA.
Giant cell arteritis (GCA) is the most common vasculopathy in patients over the age of 50. The majority of data on the geo-epidemiology of GCA is derived from Scandinavia, although there is very good documentation and epidemiological descriptions from studies throughout Europe and North America. There remains, however, a paucity of data on the incidence and prevalence of GCA in North American minority populations, as well as from Africa or Asia. The data that does exist suggests that the incidence of GCA is lower in Hispanic, Asian, and African American populations. It is interesting to note that as the population throughout the world continues to age, we anticipate an increased prevalence of disease based upon increases in annual incidence and improved survival. Considerable research is still needed to identify genetic, environmental, and gender-specific factors that influence not only the etiology, but also the natural history of disease.
Miguel A Gonzalez-Gay, Jose A Miranda-Filloy, Maria J Lopez-Diaz, Roberto Perez-Alvarez, Carlos Gonzalez-Juanatey, Amalia Sanchez-Andrade, Javier Martin, Javier Llorca
Division of Rheumatology, Hospital Xeral-Calde, Lugo, Spain. email@example.com
To continue our investigation of the epidemiology of giant cell arteritis (GCA) in southern Europe, we assessed the potential presence of trends, peaks, and fluctuations in the incidence of this vasculitis over a 25-year period in the Lugo region of northwestern Spain. We also sought to determine whether changes in the clinical spectrum of the disease existed. From 1981 to 2005, biopsy-proven GCA was diagnosed in 255 Lugo residents. The age- and sex-adjusted annual incidence rate was 10.13 (95% confidence interval [CI], 8.93-11.46) per 100,000 population aged 50 years and older. The mean age +/- SD at the time of diagnosis was 75.0 +/- 6.9 years. The annual incidence rate in women (10.23; 95% CI, 8.60-12.08) was slightly greater than that in men (9.92; 95% CI, 8.19-11.89)(p = 0.15). The annual incidence rate increased with advancing age up to a maximum of 23.16 (95% CI, 19.52-27.28) in the 70-79 year age-group. A progressive increase in the incidence was observed from 1981 through 2000 (p = 0.001). However, the age- and sex-adjusted incidence rate for biopsy-proven GCA in the Lugo region did not show peaks in the annual incidence of GCA. Likewise, we observed no seasonal pattern for the diagnosis of the disease. Visual ischemic manifestations and irreversible visual loss were observed in 57 (22.4%) and 32 (12.5%) of the 255 patients, respectively. A negative trend manifested by a progressive decline in the number of patients with visual ischemic manifestations (p = 0.021) or permanent visual loss (p = 0.018) was found over the 25-year period of study. The decline in the frequency of visual manifestations of GCA could not be attributed to a shorter delay to diagnosis, as no significant differences were observed when the delays to diagnosis in the 5 consecutive 5-year periods were compared. In conclusion, the current study confirms a progressive increase in the incidence of biopsy-proven GCA in northwestern Spain, and suggests that there has been a change in the clinical spectrum of the disease.
The incidence of giant cell arteritis in Jerusalem over a 25-year period: annual and seasonal fluctuations.
The Hebrew University-Hadassah Medical School, Jerusalem, and Safra Hospital, Sheba Medical Center, Tel-Hashomer, Israel.
OBJECTIVE Giant-cell arteritis (GCA) incidence is reported to be rising. A cyclic pattern of annual incidence rates and seasonal variations were reported by several groups. However, such fluctuations were not observed by others. We examined both annual and seasonal rates of GCA over a period of 25 years in Jerusalem. METHODS Charts of all patients diagnosed as GCA between 1980-2004 were reviewed. In 170 cases GCA was biopsy-proven. Thirty-six additional cases were included as they met the American College of Rheumatology GCA classification criteria. Data on the Jerusalem population throughout the study period was collected from the annual publications of the Israel Bureau of Statistics. Age- and sex-specific incidence rates per 100000 population aged>or=50 were calculated. RESULTS For the whole period, the average age-adjusted incidence rate was 11.3 per 100000, and 9.5 for the biopsy-positive cases. The female: male ratio was 1.4:1. Cyclic fluctuations of GCA incidence with 3 distinctive peaks, 8-10 years apart, were observed. Altogether, there was no apparent increase in GCA incidence during this period. Seasonal variations were observed: in 192 patients we were able to estimate the time of onset of GCA symptoms. It showed a peak in the months of May and June, with the number of patients being twice as expected for this period (p<0.001). CONCLUSION GCA onset was more common in late spring and early summer, and fluctuations in GCA annual incidence with 3 distinctive peaks were observed during a 25-year period. These suggest infectious or other environmental etiology, however thus far no such agents were proven.
Department of Ophthalmology, University of Alberta, Edmonton, Alta. firstname.lastname@example.org
BACKGROUND We present a retrospective review of all biopsy-positive cases of giant cell arteritis (GCA) presenting to a neuro-ophthalmology practice in Saskatoon, Saskatchewan. METHODS Records of 141 consecutive patients who underwent temporal artery biopsy at the Saskatoon Eye Centre from July 1998 through June 2003 were reviewed. Patients that were biopsy-positive for GCA were studied and an estimated regional incidence was calculated. Study variables included age at diagnosis, sex, ethnicity, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) level. RESULTS Of 141 patients, 37 (26%) had a positive biopsy result for GCA; 11 underwent a second biopsy for a total of 152 biopsies. The average age of the biopsy-positive patients was 76.5 (SD 8.2) years, and the female-to-male ratio was 2.4:l. There were 35 patients (95%) of European descent and 2 patients (5%) of Aboriginal descent. Twenty-three patients had both ESR and CRP testing done before starting steroids. The ESR was elevated in 19 (83%) and the CRP in 22 (96%). The estimated incidence of GCA for Saskatoon and area was 9.4 per 100,000 for people over the age of 50 years. INTERPRETATION GCA occurs primarily in people of European descent; however, it can affect North American people of Aboriginal descent. Sensitivity for the detection of GCA is higher in CRP than in ESR. The estimated incidence of GCA in Saskatoon and surrounding referral area is moderate compared with other northern areas.
Damdinsuren Boldbaatar, Xuenan Xuan, Badgar Battsetseg, Ikuo Igarashi, Banzragch Battur, Zayat Batsukh, Badarch Bayambaa, Kozo Fujisaki
National Research Center for Protozoan Diseases, Obihiro University of Agriculture and Veterinary Medicine, Inado-cho, Obihiro, Hokkaido 080-8555, Japan.
The purpose of this study was to demonstrate the occurrence of equine piroplasmosis in Mongolia, a country in which the disease occurs epidemically in different climatic conditions. Antibodies to Babesia equi and B. caballi were determined in serum samples of 254 pastured horses in different locations of Mongolia using an enzyme-linked immunosorbent assay with recombinant antigens. One hundred and eighty-five (72.8%) and 102 (40.1%) of all serum samples were positive for B. equi and B. caballi infections, respectively. In addition, 78 (30.7%) samples were positive for both B. equi and B. caballi infections. These results indicate that equine piroplasmosis is widespread in Mongolia. To our knowledge, this is the first report describing an epidemiological study on equine piroplasmosis in different geographic regions in Mongolia.
Department of Anatomy, University of Hong Kong, Faculty of Medicine Building, 21 Sassoon Road, Hong Kong SAR, People's Republic of China.
We previously reported the presence of HPV DNA in esophageal squamous cell carcinoma (ESCC) cases from Hong Kong and Sichuan. The role of HPV in the carcinogenesis of ESCC remains unclear, partly due to the large variations in infection rates reported by different studies. While some of these variations may truly reflect different HPV infection rates in ESCC among different geographic regions, differences in sensitivity and specificity of the detection methods used also contribute. In the present study, we used quantitative real-time PCR to determine the copy numbers of HPV-16 and HPV-18 in ESCC from 5 different regions of China with different incidence rates of ESCC. Conforming to our previous reports, HPV infection was detected in 2-22.2% of samples. Infection with HPV-16 was again shown to be more common than that with HPV-18 among Chinese ESCC patients. The copy number of HPV-16 in these ESCC cases ranged from < or =1 to 157 copies/genome equivalent, with 65% of samples harboring fewer than 10 copies/genome equivalent. The median copy number of HPV-18 was 4.9/genome equivalent. Assays were validated using cervical carcinoma cell lines with known copy numbers of HPV-16 or HPV-18. The relatively low HPV copy number and infection rate in ESCC suggest that HPV is unlikely to play as essential a role in the carcinogenesis of ESCC as in cervical cancer. However, with the consistent detection of oncogenic HPVs in ESCC from some regions of China, the possibility of HPV infection being one of the multiple risk factors of ESCC in some geographic areas cannot be excluded.