15. Immune System - Autoimmune Disorders Flashcards by Andrea Hardy

What are autoimmune disorders?

Conditions associated with an immune response against the body’s own tissues

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What is autoimmunity?

A breakdown of the mechanisms responsible for self-tolerance

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What are formed to fight self-antigens?

Autoantibodies

Cytotoxic T-cells

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What does the antibody-antigen reaction lead to?

Complement activation
Inflammation
Tissue damage

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Which genes are linked with autoimmune diseases?

HLA: B27, DR2, DR3, DR4

DQ2, DQ8

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What digestive tract situation is linked with autoimmune diseases?

Increased intestinal tract permeability (leaky gut)

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Systemic Lupus Erythematosus (SLE): definition

Chronic, inflammatory, autoimmune, multi-system disorder in which antibodies are formed against nuclear antigens

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Systemic Lupus Erythematosus (SLE): pathophysiology

B-cell activation increasing IgG levels against components of cell nuclei

Inability to remove immune complexes from tissue
Complement is activated causing inflammation
Impaired T-cell regulation

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Systemic Lupus Erythematosus (SLE): aetiology

Multifactorial interaction between various genetic and environmental factors
Higher oestrogen levels
Low vitamin D levels
Chronic bacterial infections common pre-diagnosis
Viral infections e.g. EBV
Smoking, silica dust (from concrete)
Oral contraceptive pill, HRT, stress, UV light, pesticides

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Systemic Lupus Erythematosus (SLE): signs and symptoms

Fever, malaise
Butterfly rash, photosensitivity, vasculitis, Raynaud’s syndrome
Joint pain - peripheral (sym/asym) - hands, knees, elbows
Pleurisy, pericarditis, hypertension
Nephritis
Lymphadenopathy, splenomegaly, anaemia, leukopenia

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Systemic Lupus Erythematosus (SLE): diagnostics

Blood tests: anti-nuclear antibodies (ANAs), anaemia, elevated ESR and complement, anti-phospholipid antibodies

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Systemic Lupus Erythematosus (SLE): allopathic treatment

Immunosuppressants
Corticosteroids
Sunscreen
NSAIDs

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Rheumatoid Arthritis: definition

Autoimmune, chronic, systemic inflammation of the synovium

Potentially affects all organs (except brain)

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Rheumatoid Arthritis: pathophysiology

RF (present in around 80% of sufferers) is an auto-antibody which is directed against a portion of IgG
Resultant immune complexes activate complement proteins leading to inflammation

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Rheumatoid Arthritis: aetiology

Genetic markers - HLA-DR4 and DR1
Infectious agents e.g. rubella, EBV
Abnormal intestinal permeability, small intestinal bacterial overgrowth (SIBO)
Smoking

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Rheumatoid Arthritis: signs and symptoms

Symmetrical/bilateral arthritis of small joints (hands and feet mostly)
Gradually spreads to more proximal structures
Progressive morning stiffness (> 1 hr)
Deformity of joints e.g. swan neck, ulnar deviation
Subcutaneous nodules around fingers/elbows
General malaise and fatigue
C1/C2 subluxation and compression of the spinal cord leading to paralysis and neurological complications
Kidney problems

Rheumatoid Arthritis: allopathic treatment

Anti-inflammatories and immunosuppressants - methotrexate (hard drug, best avoided)
Surgery

Rheumatoid Arthritis: epidemiology

Affects 1% of people worldwide; greater in women

Peak occurrence - 30-50 yrs old

Ankylosing Spondylitis: definition

Systemic autoimmune disease associated with chronic inflammation of the spine and sacroiliac joints
Often leads to spinal fusion and stiffness

Ankylosing Spondylitis: aetiology

Strong genetic association with HLA-B27 (present in 95% of patients)
Links with inflammatory bowel diseases and leaky gut
Intestinal infections such as salmonella and shigella cross reacting with HLA-B27

Ankylosing Spondylitis: signs and symptoms

Typically begins with sacroiliac and lower lumbar spine pain, before progressing up spine
Associated with worsening morning stiffness
Lower back pain improves with activity
Lumbar flattens and patients often become kyphotic
Hip and heel pain common
20% suffer acute iritis (eye infection)
Systemic symptoms - fever, fatigue, malaise

Ankylosing Spondylitis: diagnostics

Bloods - elevated inflammatory markers (CRP, ESR), positive for HLA-B27
X-ray, MRI - to reveal characteristic bamboo spine

Ankylosing Spondylitis: allopathic treatment

Anti-inflammatories

Surgery in later stages

Ankylosing Spondylitis: epidemiology

Age of onset typically 15-30 yrs old; more common in males

Hashimoto's Thyroiditis: definition

An underactive thyroid due to thyroid hormone deficiency

Hashimoto's Thyroiditis: pathophysiology

Low thyroid hormones - T4 and T3 Thyroid gland gradually destroyed by a variety of cells and antibodies - mediated immune processs Auto-antibodies develop that react with thyroglobulin and thyroid cells preventing the synthesis of thyroid hormones

Hashimoto's Thyroiditis: signs and symptoms

Tiredness, malaise, weight gain, cold intolerance, constipation, depression Slow cognition, poor memory, low libido, deep voice, menstrual changes, muscle aches, arthralgia (joint pain) Goitre, dry, brittle skin, thin hair, loss of eyebrows Myxoedema (swelling often around eyes - deposition of polysaccharides which attract water)

Hashimoto's Thyroiditis: diagnostics

Physical - slow tendon reflexes, bradycardia Blood tests - high TSH, low thyroid hormones Barnes temperature test - below 36.6C may indicate hypothyroidism

Hashimoto's Thyroiditis: allopathic treatment

Levothyroxine - thyroid hormone replacement

Graves' Disease: definition

Hypermetabolism and elevated serum levels of free thyroid hormones

Graves' Disease: pathophysiology

Increased IgG antibodies bind to TSH receptor and stimulate production of thyroid hormone

Graves' Disease: aetiology

Excessive iodine supplementation | Tumour - hypothalamic, pituitary

Graves' Disease: signs and symptoms

Nervousness, irritability, hyperactivity, unexplained weight loss, heat sensitivity, increased swelling Insomnia, palpitations, muscle weakness, frequent bowel and bladder movements, diarrhoea, fatigue (only symptom similar to hypothyroidism) Goitre (only sign similar to hypothyroidism), exophthalmos (bulging eyes), tachycardia, tremor, brisk tendon reflexes, lid lag

Graves' Disease: allopathic treatment

Carbimazole (to block thyroid activity) Radioactive iodine (to destroy part of the thyroid gland) Beta-blockers (to manage tachycardia), surgery