Do the Giant Cells disappear?

[Nagswoman]

I have not found this information anywhere. I know preds reduce the inflammation but by then the damage has already been done. Do the giant cells stay as part of the arterial infrastructure? Do they gradually get replaced with normal cells? Do they get replaced by copies of themselves?

[HeronNS]

To the best of my knowledge the giant cells disappear. This is why if one is to have a temporal biopsy it's important to get it done before or very soon after starting pred - because the giant cells, which seem hard enough to find anyway, will have been dealt with by the pred.I don't know if they return to normal size or if they are removed by the body.

[PMRpro Ambassador]

I THINK they become replaced by normal cells. Certainly the papers I can find suggest that in healed GCA there are very few giant cells compared with the diagnostic TAB. There are other hisotological findings that are recognised as healed GCA.

[tgca in reply to PMRpro]

It may seem a silly question but if, and I mean if, I ever get to 0 mgs without a flare, would I then be autoimmune-free?

[PMRpro Ambassador in reply to tgca]

I suppose it depends how you look at it. It is said the propensity to reactivate remains - so you are in remission but not cured.

[tgca in reply to PMRpro]

Hey ho but thanks!

[Hidden]

Good question. What a mystery this all seems to be. I keep thinking of it as a plumbing system but it's obviously more complex than that! Flushing the inflamation out just does't make sense! Lazy me hasn't really looked into the detail yet. But does anyone really know why the self destruction of the immune system happens!

[DorsetLady PMRGCAuk volunteer in reply to Hidden]

Ahh, the 64 million dollar question. Having looked at various sites the answer seems to be - nobody really knows other than something(!) triggers the immune system to attack its host’s (you or me) cells because it thinks they are foreign!

Just a couple of ‘explanations’ regarding GCA in particular I found -

A.

“The exact cause of giant cell arteritis is not known. The immune system has been implicated in some studies, but a direct relationship has not been positively established. Autoimmune disorders are caused when the body’s natural defenses against “foreign” or invading organisms (e.g., antibodies) begin to attack healthy tissue for unknown reasons.

Familial cases of giant cell arteritis have also been reported. Medical research indicates that some people with giant cell arteritis may have a genetic predisposition to the disease. A genetic predisposition means that a person may carry a gene for a disease but it may not be expressed unless something in the environment triggers the disease.”

B.

“Why some people develop temporal arteritis is not fully understood. It is also unclear why some groups are more at risk than others.

Aging is a risk factor, although it is not clear why. Geography, seasonal factors, and viruses have been linked, too.

Very few cases are associated with causes like an allergic reaction to drugs or toxins, although this can sometimes be the case, leading to the possibility that a recent or ongoing infection "may prompt the attack."

So good question, well presented, but no definitive answer!

[PMRpro Ambassador in reply to Hidden]

No!!!!!! As DL says - the question to end all questions! No-one knows what causes any autoimmune disorder really although a study in Finland found that supplementing neonates with vit D led to a far reduced rate of Type 1 diabetes in their teens than in a groupp of non-supplemented babies. Low vit D is commonly found alongside various autoimmune disorders. But it suggests that it is somewhere in infancy that the foundations are laid. And the further to the north you travel - the higher the incidence of PMR/GCA. But there is a sort of genetic component in that Scandinavian heritage increases the risk - not a particular gene that causes it.

[Rugger]

I remembered reading somewhere that 'giant cells' are actually an accumulation of normal sized cells which cluster together during the inflammatory process. I looked at Wikipedia and found that explanation.

They are 'multinucleated', indicating that their origin lies in more than one cell fusing to form the 'giant' cell. It would be good to imagine that the pred's anti-inflammatory action then causes this cluster to revert back to its origins - but that's just in my imagination.

We need a pathologist on board!

[Nagswoman in reply to Rugger]

Yes. I understood that too. I expect that when this happens, the immune system gets active but does not know what to do with these "alien" cells so inflammation stays until preds come along and help. Preds do not kill the cells, which is why I wondered what happens to them.

[Hidden]

Hi there,

The giant cells are actually macrophages that have infiltrated the area due to the inflammation. They are always circulating in our system along with monocytes. Their role is to get rid of bacteria and other junk. I think the disease state starts with inflammation and the macrophages show up. In GCA for some reason they get past the cell guards in the first layer of the artery and set up camp on an inner layer where they merge into giant multinucleated cells. Prednisone works to slow down the inflammation cascade involving interlukens. Actemra also works by blocking IL 6 in the inflammation pathway.

I guess if the inflammation slows down then the macrophages stop showing up.

Thoughts??

[Hidden in reply to Hidden]

Hi. Karen. What exactly is inflammation? I somehow assume this is an overreaction of the immune system that needs to be calmed to stop pain. Yet the immune system is just doing it's job. Very confusing who's in control of our own cell defences in there!! And if we can do much about it! Who or what rules cell communication? I know nothing but wondered why pain is so often associated with inflammation. Thanks for your technical input.

[Hidden in reply to Hidden]

It is kind of crazy right? Inflammation is there to fight virus, bacteria, chemicals etc.. The body puts out chemical signals to attract immune cells that proceed to go crazy in autoimmune diseases.

My question is why the inside of my temporal arteries?

[PMRpro Ambassador in reply to Hidden]

I suppose the answer is - why not?

[Hidden in reply to PMRpro]

Sadly true, especially when you consider all the different places in the body that can develop an autoimmune response.

[HeronNS in reply to PMRpro]

Didn't you once post a video showing graphically what autoimmune reactions are doing in body tissues? I don't think it was about PMR but the situation is the same.

[PMRpro Ambassador in reply to HeronNS]

I don't think it was me - but I DID post a link on the Lupus forum:

healthunlocked.com/lupusuk/...

This is the direct link (nearly forgot I can here...)

sciencealert.com/we-may-hav...

[HeronNS in reply to PMRpro]

I wonder if it was this, although this seems longer:

youtube.com/watch?v=yZ6wWuA...(Not working as expected?)

[PMRpro Ambassador in reply to Hidden]

This a good simple article:

medicalnewstoday.com/articl...

Inflammation causes pain - you can have pain without inflammation.