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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. …
Contributors Study design: JG, MS, AB and EB. Acquisition, analysis and interpretation of data: JG, MS, AD, AB and EB. Manuscript preparation: JG, MS, AB and EB. Overall supervision: MS, AB and EB.
Competing interests None declared.
Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.
Ethics approval The medical ethical committee of the University Medical Center Groningen.
Provenance and peer review Not commissioned; internally peer reviewed.