Herpes Zoster Increases Likelihood of Giant Cell Arteritis

Herpes zoster flares increase the risk of giant cell arteritis, shows a study presented on Nov. 14 at the American College of Rheumatology annual meeting in Washington, D.C.

The association was strongest when complications such as cranial nerve involvement were present, reported Bryant England of the University of Alabama, who also published related findings in Arthritis & Rheumatology.

Dr. England points to recent studies that found the varicella zoster viral antigen in the temporal arteries of patients with giant cell arteritis. This was suggestive of causality, but the studies lacked insight into the temporal relationship between the infections and the development of the arteritis.

The authors sought to determine if vaccination for herpes zoster or antiviral treatment would impact the course of new giant cell arteritis.

The study utilized a random sample comprised of 5% of Medicare patients between 2006 and 2013 and the MarketScan Commercial Claims and Encounters database between 2010 and 2014. A total of 16,664,161 patients were enrolled totaling more than 37,993,079 patient years of follow-up. Subjects could not have a prior diagnosis of giant cell arteritis or polymyalgia rheumatic and had to be over 50 years of age with a year of continuous enrollment. From the database herpes zoster events were identified and described as complicated or uncomplicated and vaccination status was determined. Finally, the incidence of giant cell arteritis was compared to herpes zoster exposure and associations described between zoster events, treatment, vaccination and arteritis.

The results reveal a doubling of risk for giant cell arteritis following complicated herpes zoster infection and a 50% increase for uncomplicated infections. No relationship was found between vaccination or antiviral therapy and giant cell arteritis. This study is the first of its kind to demonstrate that prior infection with herpes zoster increases the chances of developing giant cell arteritis in the future. Although this association is important and will likely lead to future investigation aimed at preventing giant cell arteritis, current therapies and vaccination for herpes zoster appear ineffective at this time.

Key Points

• Infection with herpes zoster increases the likelihood of developing giant cell arteritis by 50% with complicated infections doubling that chance.
• This was a very large study that for the first time was able to show a temporal relationship between herpes zoster infection and giant cell arteritis.
• Neither vaccination for herpes zoster nor treatment with antiviral mediations prevents subsequent development of giant cell arteritis.

References:

Bryant R. England. "Herpes Zoster and the Risk of Incident Giant Cell Arteritis," Abstract number 2074. 4:30 p.m., Nov. 14, 2016. ACR/ARHP 2016 Annual Meeting.