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Altitude and Giant Cell Arteritis To the Editor: Major interest has been directed to establishing etiological factors in primary systemic vasculitides. Interestingly, Mittal, et al recently described the potential influence of altitude in the disease development and relapses in a patient with Churg-Strauss syndrome1. Giant cell arteritis (GCA) is the most common primary systemic vasculitis in Europe and North America in people older than 50 years of age2. Since genetic influences cannot explain the great variation in the incidence of GCA in different parts of the world2, we investigated the potential role of altitude as a geographical factor that might be implicated in the incidence of GCA in the Lugo region of Northwest Spain3. However, when we assessed the altitude of the site of residence in 210 patients from that region, we could find no differences in disease incidence related to this variable3. Also, in a reappraisal of relapse of the disease, we confirmed what had been reported4,5. We observed that relapse in Lugo patients occurred mainly when prednisone dose was less than 10 mg/day, and it generally presented as polymyalgia rheumatica or was associated with headache or asthenia. We could find no implication of the altitude of the site of residence in the incidence of relapse of GCA. Nevertheless, since the range of altitude in the Lugo region is not very broad, additional studies in regions with broader ranges of altitude would be required to definitively exclude the role of this factor in the development of GCA. JAVIER LLORCA, MD, PhD; MARIA BRINGAS-BOLLADA, MD, Division of Preventive Medicine, Universidad de Cantabria, Santander; CARLOS GARCIA-PORRUA, MD, PhD; MIGUEL A. GONZALEZ-GAY, MD, PhD, Rheumatology Division, Hospital Xeral-Calde, Lugo, Spain. REFERENCES 1. Mittal G, Hasso N, Maddison P. Primary vasculitis at high altitude. J Rheumatol 2004;31:1450-1. 2. Gonzalez-Gay MA, Garcia-Porrua C. Epidemiology of the vasculitides. Rheum Dis Clin North Am 2001;27:729-49. 3. Llorca J, Bringas-Bollada M, Amor-Dorado JC, Garcia-Porrua C, Gonzalez-Gay MA. Lack of association between altitude and incidence of giant cell arteritis in Northwest Spain [letter]. Clin Exp Rheumatol 2004;22:270. 4. Gonzalez-Gay MA, Alonso MD, Aguero JJ, Bal M, Fernandez-Camblor B, Sanchez-Andrade A. Temporal arteritis in a northwestern area of Spain: study of 57 biopsy proven patients. J Rheumatol 1992;19:277-80. 5. Gonzalez-Gay MA, Garcia-Porrua C, Vazquez-Caruncho M, Dababneh A, Hajeer A, Ollier WE. The spectrum of polymyalgia rheumatica in northwestern Spain: incidence and analysis of variables associated with relapse in a 10 year study. J Rheumatol 1999;26:1326-32. |