Division of Rheumatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA.
Ann Rheum Dis. 2017 Jun;76(6):1031-1035. doi: 10.1136/annrheumdis-2016-210152. Epub 2016 Nov 28.
Alterations in the immune system and infections are suspected to increase susceptibility to giant cell arteritis (GCA). Recently herpes zoster has been directly implicated in the pathogenesis of GCA. We examined the association between prior infections, in particular herpes zoster, and incident GCA in a population-based cohort.
A nested case-control study was performed using an electronic database from the UK. Cases with newly diagnosed GCA were identified using a validated algorithm and compared with age-matched, sex-matched and practice-matched controls. Conditional logistic regression was used to examine the relationship between any infection or herpes zoster infection on the development of GCA after adjusting for potential confounders; results were expressed as incidence rate ratios (IRRs).
There were 4559 cases of GCA and 22 795 controls. Any prior infection and herpes zoster were associated with incident GCA (IRR 1.26 (95% CI 1.16 to 1.36), p<0.01; and 1.17 (95% CI 1.04 to 1.32), p<0.01, respectively). A greater number of infections was associated with a higher risk of developing GCA (IRR for 1, 2-4 and ≥5 infections was 1.28, 1.60 and 2.18, respectively).
Antecedent infections and, to a lesser extent, herpes zoster infections are modestly associated with incident GCA. These data provide population-level support for the hypothesis that long-standing alterations of the immune system are associated with susceptibility to GCA and suggest that herpes zoster is unlikely to play a major causal role in the pathogenesis of GCA.
免疫系统改变和感染被怀疑会增加巨细胞动脉炎（GCA）的易感性。最近，带状疱疹已被直接牵连到 GCA 的发病机制中。我们在基于人群的队列中研究了先前感染，特别是带状疱疹与新发 GCA 之间的关联。
使用英国的电子数据库进行嵌套病例对照研究。使用经过验证的算法确定新诊断为 GCA 的病例，并将其与年龄、性别和实践匹配的对照进行比较。使用条件逻辑回归在调整潜在混杂因素后，检查任何感染或带状疱疹感染与 GCA 发展之间的关系；结果表示为发病率比（IRR）。
共有 4559 例 GCA 和 22795 例对照。任何先前的感染和带状疱疹与新发 GCA 相关（IRR 1.26（95%CI 1.16 至 1.36），p<0.01；和 1.17（95%CI 1.04 至 1.32），p<0.01）。感染次数越多，发生 GCA 的风险越高（IRR 为 1、2-4 和≥5 次感染分别为 1.28、1.60 和 2.18）。
先前的感染，以及在较小程度上，带状疱疹感染与新发 GCA 有一定的关联。这些数据为长期免疫改变与 GCA 易感性相关的假说提供了人群水平的支持，并表明带状疱疹不太可能在 GCA 的发病机制中发挥主要的因果作用。
