In Reply Regarding Almaghlouth and colleagues’ queries, our article1 noted that a patient was considered giant cell arteritis (GCA) negative when that patient had clinical features that led to a temporal artery (TA) biopsy but the biopsy did not reveal GCA pathology. Regarding aging, all participants, including control individuals, were older than 50 years, but only GCA-positive and GCA-negative participants had a significantly increased frequency of varicella-zoster virus (VZV) in their TAs. Regarding immunosuppression, while we were not privy to information regarding steroid treatment from deidentified patients outside our institution, virtually all TA biopsies performed at the University of Colorado were obtained before steroid treatment. Furthermore, while many control TAs were obtained from cadavers who had been immunosuppressed before death, VZV was detected in only 22% of these control TAs. Overall, there is no evidence that steroids or immunosuppression played a role in the significantly increased detection of VZV in 73% of GCA-positive and 64% of GCA-negative TAs.
Nagel MA, White T, Gilden D. Varicella-Zoster Virus in Giant Cell Arteritis—Reply. JAMA Neurol. 2016;73(2):239. doi:10.1001/jamaneurol.2015.3871