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. Fever of unknown origin is one of the symptoms. Along with polymyalgia rheumatica, a related clinical syndrome, it is strongly associated with DR4 positivity. (187360 TEMPORAL ARTERITIS Alternative titles; symbols GIANT CELL ARTERITIS; GCA; CRANIAL ARTERITIS; POLYMYALGIA RHEUMATICA. OMIM; HLA-DRB1 allele distribution in polymyalgia rheumatica and giant cell arteritis: influence on clinical subgroups and prognosis. VM Martínez-Taboda, MJ Bartolome, M Lopez-Hoyos, R Blanco, C Mata, J Calvo, A Corrales, V Rodriguez-Valverde. Semin Arthritis Rheum 2004 Aug;34(1):454-464.)

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. 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."

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.

Is giant cell arteritis an infectious disease? Biological and epidemiological evidence. P Duhaut, S Bosshard, JP Ducroix. Presse Med 2004 Nov 6;33(19 Pt 2):1403-1408. Review.

Infection and temporal arteritis: a PCR-based study to detect pathogens in temporal artery biopsy specimens. RJ Cooper, S D'Arcy, M Kirby, M Al-Buhtori, MJ Rahman, L Proctor, RE Bonshek. J Med Virol 2008 Mar;80(3):501-505. "Samples from 37 temporal artery biopsies with histological evidence of arteritis and 66 samples from histologically negative temporal artery biopsies, all from different patients, were negative for C. pneumoniae, HSV, VZV, EBV, and HHV7 DNA. Two of the 37 histologically positive specimens were positive for HHV6, another two for CMV and a further two for parvovirus B19 DNA. Parvovirus B19 DNA was also detected in five histologically negative biopsies, one positive for HCMV DNA and a further one was positive for HHV6 DNA. There is no statistically significant difference to the presence of virus DNA in the two types of specimens (P = 0.538)."

Serum levels of antibodies to Chlamydia pneumoniae and human HSP60 in giant cell arteritis patients. M López-Hoyos, L Alvarez, M Ruiz Soto, R Blanco, M José Bartolomé, VM Martínez-Taboada. Clin Exp Rheumatol 2008 Nov-Dec;26(6):1107-1110. "17 GCA patients, 39 polymyalgia rheumatica (PMR) patients and 23 age-matched healthy subjects.RESULTS:Serum IgG anti-hHSP60, but not anti-C. pneumoniae, antibodies were significantly increased in GCA patients in comparison with PMR patients or healthy controls. After steroid therapy, both anti-hHSP60 and -C. pneumoniae antibodies decreased significantly in both groups of patients."

Acute Chlamydia pneumoniae infection in the pathogenesis of autoimmune diseases. M Fujita, S Hatachi, M Yagita. Lupus 2009 Feb;18(2):164-168. 82 patients with several autoimmune diseases and 70 controls. "Chlamydia pneumoniae IgM positive cases were more frequent among the patients with rheumatoid arthritis (RA; 30%, P < 0.05), systemic lupus erythematosus (SLE; 28.0%, P < 0.05), dermatomyositis/polymyositis (23%, NS), myeloperoxidase-antineutrophil cytoplasmic autoantibody (MPO-ANCA)-associated vasculitis (33%, NS), adult onset of Still's disease (29%, NS) and giant cell arteritis/Takayasu arteritis (50%, NS) than among the controls. This positive frequency was statistically significant in RA and SLE."

No Correlation Between Giant Cell Arteritis and Chlamydia pneumoniae Infection: Investigation of 189 Patients With Standard and Improved PCR Methods. F Njau, T Ness, U Wittkop, T Pancratz, M Eickhoff, AP Hudson, H Haller, AD Wagner. J Clin Microbiol 2009 Apr 22. [Epub ahead of print]. "189 temporal artery biopsies from giant cell arteritis (GCA) patients were investigated using sensitive PCR targeting Chlamydia pneumoniae. Chlamydial DNA was detected in 17 samples, 11/17 were positive for chlamydial antigen."

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 05-24-09