Giant cell arteritis is an inflammation of the medium and large-sized arteries, mainly of the outermost of their three layers, the adventitia. It is known to be associated with previous upper respiratory tract symptoms. The occurrence of cases is often clustered in certain time periods and geographic locations. It is primarily a disease of the elderly, and is more common in women than in men.

Along with polymyalgia rheumatica, a related clinical syndrome, it is strongly associated with DR4 positivity. However, this should not be construed to mean that it is an "autoimmune" disease (ie, unprovoked attack of healthy tissues). The clinical course of such clearly pathogen-driven diseases as tuberculosis is also influenced by tissue type.

In this study, 8 of 9 GCA patients were PCR-positive for Chlamydia pneumoniae, while the only one of nine controls who was positive for CP had respiratory symptoms. In some of the tissue specimens, CP was found outside of cells, "possibly suggesting that the organism was viable and undergoing active vegetative growth in temporal artery tissues in GCA patients."

Detection of Chlamydia pneumoniae in giant cell vasculitis and correlation with the topographic arrangement of tissue-infiltrating dendritic cells. AD Wagner, HC Gerard, T Fresemann, WA Schmidt, E Gromnica-Ihle, AP Hudson, H Zeidler. Arthritis and Rheumatism 2000 Jul;43(7):1543-1551.

Temporal arteritis associated with Chlamydia pneumoniae DNA detected in an artery specimen. G Haugeberg, R Bie, SA Nordbo. J Rheumatol 2001 Jul;28(7):1738-1739. Letter; no abstract.

Autoimmunity Research Foundation

The Autoimmunity Research Foundation conducts research on the role of C. pneunoniae in sarcoidosis. Trevor G. Marshall, the Chairman, says that no single antibiotic among those cited for use against C. pneumoniae (Rifampin, Azithromycin, Gatifloxacin, and Clarithromycin) has any effect against these intra-phagocytic bacteria. (Rapid Response. Intra-mononuclear-cell Bacteria are Key to much Chronic Disease. GT Marshall. BMJ 2005 Aug. 12).

Uveitis

Detection of serum antibodies to Chlamydia pneumoniae in patients with endogenous uveitis and acute conjunctivitis. K Numazaki, S Chiba, K Aoki, K Suzuki, S Ohno. Clin Infect Dis 1997 Oct;25:928-929. "We determined the titer of serum antibodies to C. pneumoniae for 48 adult patients with endogenous uveitis (29 had sarcoidosis, 10 had Behcet's disease, and 9 had Vogt-Kyanagi disease) and for 28 adult patients with acute conjunctivitis. We also determined the titer of serum antibodies to C. pneumoniae in 30 healthy adults who served as controls... Of 30 healthy adults, IgG antibodies to C. pneumoniae were detected in 17 (56.7%), and IgA antibodies were detected in 15 (50.0%). IgM antibodies to C. pneumoniae were detected in 6 (20%) adults. Of 29 patients with sarcoidosis, IgG antibodies to C. pneumoniae were detected in 21 (72.4%), and IgA antibodies were detected in 15 (51.7%); IgM antibodies to C. pneumoniae were detected in 17 (58.6%) patients. IgG antibodies to C. pneumoniae were detected in seven (70%) of 10 patients with Behcet's disease and in three (33%) of nine patients with Vogt-Koyanagi disease. Neither IgA nor IgM antibodies to C. pneumoniae were detected in the patients with Behcet's or Vogt-Koyanagi disease. Of 28 patients with acute conjunctivitis, IgG antibodies to C. pneumoniae were detected in 16 (57.1%); in 2 (7.1%) of these patients, IgA and IgM antibodies to C. pneumoniae were detected. The prevalence of serum IgA and IgM antibodies to C. pneumoniae in patients with endogenous uveitis associated with sarcoidosis was significantly higher than that in patients with other endogenous uveitis (P< 0.01; t-test; Welch's modification).

Chlamydial antibodies in patients with previous acute anterior uveitis. M Huhtinen, M Puolakkainen, K Laasila, M Sarvas, A Karma, M Leirisalo-Repo. Invest Ophthalmol Vis Sci 2001 Jul;42(8):1816-1819. IgA antibodies to C pneumoniae heat shock protein 60 in patients vs controls, P = 0.0001.

cast 05-08-12