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Research ArticleVasculitis

Infections Are Associated With Increased Risk of Giant Cell Arteritis: A Population-based Case-control Study from Southern Sweden

Pavlos Stamatis, Aleksandra Turkiewicz, Martin Englund, Göran Jönsson, Jan-Åke Nilsson, Carl Turesson and Aladdin J Mohammad
The Journal of Rheumatology February 2021, 48 (2) 251-257; DOI: https://doi.org/10.3899/jrheum.200211
Pavlos Stamatis
1P. Stamatis, MD, Consultant in Rheumatology, Department of Clinical Sciences, Rheumatology, Lund University, Lund;
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  • ORCID record for Pavlos Stamatis
  • For correspondence: pavlos.stamatis@med.lu.se
Aleksandra Turkiewicz
2A. Turkiewicz, MSc, PhD, CStat, M. Englund, MD, PhD, Professor of Epidemiology, Department of Clinical Sciences, Clinical Epidemiology Unit, Lund University, Lund;
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Martin Englund
2A. Turkiewicz, MSc, PhD, CStat, M. Englund, MD, PhD, Professor of Epidemiology, Department of Clinical Sciences, Clinical Epidemiology Unit, Lund University, Lund;
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Göran Jönsson
3G. Jönsson, MD, PhD, Associate Professor of Infection Medicine, Department of Clinical Sciences, Infection Medicine, Lund University, Lund;
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Jan-Åke Nilsson
4J.Å.Nilsson, BS, Statistician, Department of Clinical Sciences, Rheumatology, Lund University, Lund, Department of Clinical Sciences Malmö, Rheumatology, Lund University, Malmö;
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Carl Turesson
5C. Turesson, MD, PhD, Professor of Rheumatology, Department of Clinical Sciences Malmö, Rheumatology, Lund University, Malmö;
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Aladdin J Mohammad
6A.J. Mohammad, MD, MPH, PhD, Associate Professor of Rheumatology, Senior Consultant Rheumatologist, Department of Clinical Sciences, Rheumatology, Lund University, Lund, Department of Clinical Sciences Lund, Clinical Epidemiology Unit, Lund University, Lund, Sweden, Department of Medicine, University of Cambridge, Cambridge, UK.
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Abstract

Objective. To investigate the association between infections and the subsequent development of giant cell arteritis (GCA) in a large population-based cohort from a defined geographic area in Sweden.

Methods. Patients diagnosed with biopsy-confirmed GCA between 2000 and 2016 were identified through the database of the Department of Pathology in Skåne, the southernmost region of Sweden. For each GCA case, 10 controls matched for age, sex, and area of residence were randomly selected from the general population. Using the Skåne Healthcare Register, we identified all infection events prior to patients’ date of GCA diagnosis and controls’ index date. With infection as exposure, a conditional logistic regression model was employed to estimate the OR for developing GCA. The types of infections contracted nearest in time to the GCA diagnosis/index date were identified.

Results. A total of 1005 patients with biopsy-confirmed GCA (71% female) and 10,050 controls were included in the analysis. Infections were more common among patients subsequently diagnosed with GCA compared to controls (51% vs 41%, OR 1.78, 95% CI 1.53–2.07). Acute upper respiratory tract infection (OR 1.77, 95% CI 1.47–2.14), influenza and pneumonia (OR 1.72, 95 % CI 1.35–2.19), and unspecified infections (OR 5.35, 95 % CI 3.46–8.28) were associated with GCA. Neither skin nor gastrointestinal infections showed a correlation.

Conclusion. Infections, especially those of the respiratory tract, were associated with subsequent development of biopsy-confirmed GCA. Our findings support the hypothesis that a range of infections may trigger GCA.

Key Indexing Terms:
  • epidemiology
  • giant cell arteritis
  • infections
  • risk factors
  • vasculitis
  • Accepted for publication May 4, 2020.
  • Copyright © 2021 by the Journal of Rheumatology
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1 Feb 2021
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Infections Are Associated With Increased Risk of Giant Cell Arteritis: A Population-based Case-control Study from Southern Sweden
Pavlos Stamatis, Aleksandra Turkiewicz, Martin Englund, Göran Jönsson, Jan-Åke Nilsson, Carl Turesson, Aladdin J Mohammad
The Journal of Rheumatology Feb 2021, 48 (2) 251-257; DOI: 10.3899/jrheum.200211

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Infections Are Associated With Increased Risk of Giant Cell Arteritis: A Population-based Case-control Study from Southern Sweden
Pavlos Stamatis, Aleksandra Turkiewicz, Martin Englund, Göran Jönsson, Jan-Åke Nilsson, Carl Turesson, Aladdin J Mohammad
The Journal of Rheumatology Feb 2021, 48 (2) 251-257; DOI: 10.3899/jrheum.200211
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Keywords

EPIDEMIOLOGY
GIANT CELL ARTERITIS
INFECTIONS
RISK FACTORS
VASCULITIS

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