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Giant cell arteritis cluster suggests possible link to localized toxic contamination
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 Jared D. Peterson |
PHILADELPHIA — A small cluster of giant cell arteritis cases may be associated with the presence of environmental toxins, a speaker told colleagues here.
"No definite conclusions can be drawn from this and we present it here as merely a finding of interest, but we seem to have a geographical clustering of multiple cases of giant cell arteritis in a relatively small population that had long-term exposure to a potential hazardous source with onset that may be earlier than is typically seen," Jared D. Peterson, MD, said at the Wills Eye Institute Alumni Conference.
The retrospective study focused on four cases of giant cell arteritis (GCA) that occurred within a 1-mile radius of a Philadelphia factory that produced alcoholic beverages, industrial alcohol products and other chemicals before it closed in 1986.
The patients were a mean 65.5 years old at the time of diagnosis. The patients were examined and not found to have comorbidities related to GCA. However, they had an earlier onset of GCA than widely reported in the literature. Mean age at GCA onset is typically in the low- to mid-70s.
Investigators plan to examine more patients to determine whether the neighborhood and the wider region have a statistically significant prevalence of GCA, Dr. Peterson said.
- Disclosure: Dr. Peterson reported no relevant financial relationships.
This report suggests that giant cell arteritis (GCA) could be caused by an environmental toxin or contamination. Although no previous researchers have ever suggested GCA is caused by a toxic exposure, Gordon et al. Clin Immunol 2004;111(3):286-296 identified candidate microbial DNA sequences in biopsy specimens from GCA patients. This group and others have suggested that GCA might be caused by an infectious organism. One could speculate that the factory site identified in this article is contaminated by one of the causative organisms.
Specific HLA subtypes are associated with GCA and GCA primarily affects Caucasians. This evidence suggests that GCA patients have a genetic predisposition toward the disease. On the other hand, conjugal GCA has been reported, consistent with an environmental trigger. Proliferating T-cells have been identified in biopsy specimens, but not in peripheral blood, suggesting that the T-cells are reacting to an in-situ antigen. Taken together with the present report, it seems likely that GCA occurs in patients with a genetic predisposition who are then exposed to an as-of-yet unidentified environmental trigger.
The treatment of GCA has not changed in more than 40 years and it seems that the treatment of this disease will not change until these environmental triggers are identified.
– Bradley Katz, MD, PhD
Associate
Professor of Ophthalmology and Neurology, University of Utah Health Sciences
Center
Disclosure: Dr. Katz has no financial relationships to disclose.