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Artery tertiary lymphoid organs in giant cell arteritis are not exclusively located in the media of temporal arteries.
  1. Jacoba Carolien Graver1,
  2. Maria Sandovici1,
  3. Arjan Diepstra2,
  4. Annemieke M H Boots1,
  5. Elisabeth Brouwer1
  1. 1Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
  2. 2Department of Pathology and Medical Biology, University of Groningen, Universitair Medisch Centrum Groningen, Groningen, Netherlands
  1. Correspondence to Dr Elisabeth Brouwer, Department of Rheumatology and Clinical Immunology, UMCG, Hanzeplein 1, 9713 GZ Groningen, Netherlands; e.brouwer{at}

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With great interest, we read the article by Ciccia et al, about artery tertiary lymphoid organs (ATLOs) in giant cell arteritis (GCA) and the association with ectopic expression of constitutive lymphoid tissue-homing chemokines.1 In 50 patients with biopsy-proven GCA that fulfilled the 1990 ACR classification criteria2 and had temporal transmural inflammation, Ciccia et al documented the presence of ATLOs in 60% of the patients. In their study, ATLOs were defined as inflammatory aggregates that displayed a well-defined compartmentalisation of T and B cells. The authors state that ATLOs were exclusively located in the media of the temporal artery. In addition, the authors mention that the location of ATLOs in the media of the inflamed temporal artery is peculiar and deviating from the ‘classic’ adventitial location of ATLOs, as, for instance, seen in atherosclerosis.3 4 However, the figures included in the article do not convincingly provide evidence that the ATLO location is in the media.

Until recently, B cells have received little attention as putative players in the immunopathology of GCA. B cells and germinal centre formation were reported to be absent from vascular infiltrates, and in spite of several attempts, no disease-specific autoantibody production has been identified. …

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