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Research ArticleCorrespondence

Dr. Trefond et al reply: Giant Cell Arteritis After SARS-CoV-2 Vaccination—Coincidence or Trigger ?

Ludovic Trefond, Agathe Sauret, Julien Stievenart, Louis Olagne, Benedicte Guelon, Perrine Smets, Olivier Aumaître and Marc André
The Journal of Rheumatology August 2022, 49 (8) 964; DOI: https://doi.org/10.3899/jrheum.211158
Ludovic Trefond
1CHU Clermont-Ferrand, Service de Médecine Interne, Hôpital Gabriel Montpied;
2Université Clermont Auvergne, Inserm U1071, INRA USC2018, M2iSH, Clermont-Ferrand, France.
MD
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  • ORCID record for Ludovic Trefond
  • For correspondence: ludovic.trefond@chu-clermontferrrand.fr
Agathe Sauret
1CHU Clermont-Ferrand, Service de Médecine Interne, Hôpital Gabriel Montpied;
MD
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Julien Stievenart
1CHU Clermont-Ferrand, Service de Médecine Interne, Hôpital Gabriel Montpied;
MD
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Louis Olagne
1CHU Clermont-Ferrand, Service de Médecine Interne, Hôpital Gabriel Montpied;
MD
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Benedicte Guelon
1CHU Clermont-Ferrand, Service de Médecine Interne, Hôpital Gabriel Montpied;
MD
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Perrine Smets
1CHU Clermont-Ferrand, Service de Médecine Interne, Hôpital Gabriel Montpied;
MD
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Olivier Aumaître
1CHU Clermont-Ferrand, Service de Médecine Interne, Hôpital Gabriel Montpied;
2Université Clermont Auvergne, Inserm U1071, INRA USC2018, M2iSH, Clermont-Ferrand, France.
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Marc André
1CHU Clermont-Ferrand, Service de Médecine Interne, Hôpital Gabriel Montpied;
2Université Clermont Auvergne, Inserm U1071, INRA USC2018, M2iSH, Clermont-Ferrand, France.
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This article has a correction. Please see:

  • Errata - July 01, 2022

We thank Conway et al1 for their comments on our article reporting a case of giant cell arteritis (GCA) after SARS-CoV-2 vaccination.2 We agree with Conway et al1 and also emphasize the interest in SARS-CoV-2 vaccination, which had a reassuring safety profile in a cohort of 1519 patients with rheumatic and musculoskeletal diseases.3

Indeed, the association between GCA and the SARS-CoV-2 vaccination could have been pure coincidence, but we know that there are trigger factors without being able to confirm if they are causal factors. This association has also been reported in antineutrophil cytoplasmic antibody–associated vasculitis4 and we agree that we need large epidemiological studies to ascertain the potential relationship.

In the title of our study, we emphasized the particular phenotype of this case, which was a low level of C-reactive protein (CRP).2 The random incidence of GCA in France estimated by Conway et al1 would be very different with low levels of CRP. In our cohort from 2004 to 2020 of 116 patients with positive temporal artery biopsy (TAB), we had 2 patients (1.7%) with an initial CRP level < 10 mg/L and none ≤ 5 mg/L (unpublished data). The proportion was similar (2/119, 1.7%) in the cohort from Parikh et al5 in 2006.

Our message2 was addressed not to the general population but to clinicians so as to help in diagnosis. Patients may indeed pay more attention to their symptoms after vaccination since they are asked to do so, but some diagnoses can hide behind these symptoms, and we know the potential damage caused by GCA. Patient history should include vaccinations. Further, when the symptoms presented are compatible with GCA, a CRP level ≤ 5 mg/L should not rule out a GCA diagnosis and a TAB should be performed.

Footnotes

  • The authors declare no conflicts of interest relevant to this article.

  • Copyright © 2022 by the Journal of Rheumatology

References

  1. 1.↵
    1. Conway R,
    2. Brouwer E,
    3. Geest KSM van der, et al
    . Dr. Conway et al reply. J Rheumatol 2021 Oct 1 (Epub ahead of print).
  2. 2.↵
    1. Sauret A,
    2. Stievenart J,
    3. Smets P, et al
    . Case of giant cell arteritis after SARS-CoV-2 vaccination: a particular phenotype? J Rheumatol 2021 Oct 1 (Epub ahead of print).
  3. 3.↵
    1. Machado PM,
    2. Lawson-Tovey S,
    3. Hyrich K, et al
    . Covid-19 vaccine safety in patients with rheumatic and musculoskeletal disease. Ann Rheum Dis 2021;80:199-200.
    OpenUrlAbstract/FREE Full Text
  4. 4.↵
    1. Villa M,
    2. Díaz-Crespo F,
    3. Pérez de José A, et al
    . A case of ANCA-associated vasculitis after AZD1222 (Oxford-AstraZeneca) SARS-CoV-2 vaccination: casualty or causality? Kidney Int 2021;100:937-8.
    OpenUrl
  5. 5.↵
    1. Parikh M,
    2. Miller NR,
    3. Lee AG, et al
    . Prevalence of a normal C-reactive protein with an elevated erythrocyte sedimentation rate in biopsy-proven giant cell arteritis. Ophthalmology 2006; 113:1842-5.
    OpenUrlCrossRefPubMed
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Dr. Trefond et al reply: Giant Cell Arteritis After SARS-CoV-2 Vaccination—Coincidence or Trigger ?
Ludovic Trefond, Agathe Sauret, Julien Stievenart, Louis Olagne, Benedicte Guelon, Perrine Smets, Olivier Aumaître, Marc André
The Journal of Rheumatology Aug 2022, 49 (8) 964; DOI: 10.3899/jrheum.211158

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Dr. Trefond et al reply: Giant Cell Arteritis After SARS-CoV-2 Vaccination—Coincidence or Trigger ?
Ludovic Trefond, Agathe Sauret, Julien Stievenart, Louis Olagne, Benedicte Guelon, Perrine Smets, Olivier Aumaître, Marc André
The Journal of Rheumatology Aug 2022, 49 (8) 964; DOI: 10.3899/jrheum.211158
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