SEARCH

SEARCH BY CITATION

To the Editor:

I read with great interest the article by Durand and Thomas published in a recent issue of Arthritis Care & Research regarding the incidence of infections in patients with giant cell arteritis (GCA) (1). As the authors note, glucocorticoids suppress T cell–mediated cellular immunity and have potent suppressive effects on the effector functions of phagocytes. I recently saw a patient with GCA receiving treatment with corticosteroids. In a routine analysis 6 months after diagnosis, her serum IgG level was low (454 mg/dl). She had no history of hypogammaglobulinemia, and IgG levels were normal 6 months before, when she was diagnosed with GCA. Since the diagnosis of vasculitis, she had several urinary tract infections. While searching for the cause of hypogammaglobulinemia, I found that it could be associated with steroid therapy (2ndash;4). There is disagreement about whether the hypogammaglobulinemia associated with glucocorticoids is associated with a higher prevalence of infections (5) and, to my knowledge, no study has evaluated the effect of glucocorticoids on immunoglobulin levels in patients with GCA.

REFERENCES

  1. Top of page
  • 1
    Durand M, Thomas SL. Incidence of infections in patients with giant cell arteritis: a cohort study. Arthritis Care Res (Hoboken) 2011; 64: 5818.
  • 2
    Settipane GA, Pudupakkam RK, McGowan JH. Corticosteroid effect on immunoglobulins. J Allergy Clin Immunol 1978; 62: 1626.
  • 3
    Kawano T, Matsuse H, Obase Y, Kondo Y, Machida I, Tomari S, et al. Hypogammaglobulinemia in steroid-dependent asthmatics correlates with the daily dose of oral prednisolone. Int Arch Allergy Immunol 2002; 128: 2403.
  • 4
    Lee RJ, Fay AC. Hypogammaglobulinaemia associated with long term, low dose steroid therapy. Postgrad Med J 1985; 61: 5234.
  • 5
    Fedor ME, Rubinstein A. Effects of long-term low-dose corticosteroid therapy on humoral immunity. Ann Allergy Asthma Immunol 2006; 97: 1136.

Francisco José Fernández-Fernández MD*, * Hospital Arquitecto Marcide, Ferrol, Spain.