15. Immune System - Autoimmune Disorders Flashcards
What are autoimmune disorders?
Conditions associated with an immune response against the body’s own tissues
What is autoimmunity?
A breakdown of the mechanisms responsible for self-tolerance
What are formed to fight self-antigens?
Autoantibodies
Cytotoxic T-cells
What does the antibody-antigen reaction lead to?
Complement activation
Inflammation
Tissue damage
Which genetic markers are linked with autoimmune diseases?
HLA: B27, DQ2, DR2, DR3, DR4
What digestive tract situation is linked with autoimmune diseases?
Increased intestinal tract permeability (leaky gut)
Systemic Lupus Erythematosus (SLE): definition
Chronic, inflammatory, autoimmune, multi-system disorder in which antibodies are formed against nuclear antigens
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
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 can all cause flare-ups
Systemic Lupus Erythematosus (SLE): signs and symptoms
Fever, malaise
Butterfly rash, photosensitivity, vasculitis (pain in fingertips), Raynaud’s syndrome (arteries in spasm)
Joint pain - peripheral (sym/asym) - hands, knees, elbows
Pleurisy, pericarditis, hypertension
Nephritis (nephrotic syndrome)
Lymphadenopathy, splenomegaly, anaemia, leukopenia
Systemic Lupus Erythematosus (SLE): diagnostics
Blood tests: anti-nuclear antibodies (ANAs), anaemia, elevated ESR and complement, anti-phospholipid antibodies
Systemic Lupus Erythematosus (SLE): allopathic treatment
Immunosuppressants
Corticosteroids
Sunscreen*
NSAIDs
*This has a consquence for Vit D deficiency
Rheumatoid Arthritis: definition
Autoimmune, chronic, systemic inflammation of the synovium
Potentially affects all organs (except brain)
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
Rheumatoid Arthritis: aetiology
Genetic markers - HLA-DR4 and DR1
Infectious agents e.g. rubella, EBV
Abnormal intestinal permeability, small intestinal bacterial overgrowth (SIBO)
Smoking
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 / pulmonary problems
Rheumatoid Arthritis: allopathic treatment
Anti-inflammatories and immunosuppressants
Immunomodulators - 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
Urogenital or intestinal infections such as salmonella and shigella can cross react 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 lordosis flattens and patients often become kyphotic
Hip and heel pain common
20% suffer acute iritis* (eye infection)
Systemic symptoms - fever, fatigue, malaise
*linked to HLA B27
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
(NSAIDs and steroids)
Surgery in later stages
Ankylosing Spondylitis: epidemiology
- Age of onset typically 15-30 yrs old
- More common in males
Hashimoto’s Thyroiditis: definition
Autoimmune condition causing hypothyroidism
Hashimoto’s Thyroiditis: pathophysiology
Thyroid gland gradually destroyed by a variety of cell- and antibody-mediated immune processes
Auto-antibodies develop that react with thyroglobulin and thyroid cells preventing the synthesis of thyroid hormones
Leading to low thyroid hormones - T4 and T3
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
Autoimmune condition causing hyperthyroidism
Graves’ Disease: pathophysiology
Increased IgG antibodies bind to TSH receptors and stimulate production of thyroid hormones
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
*Can result in hypothyroidism
What can be used to confirm increased intestinal permeability (leaky gut) ?
**Not on slides
Comprehensive stool analysis can show markers such as zonulin
What is zonulin ?
Not on slides
A protein that plays a role in regulating the permeability of the intestinal mucosal barrier
Is is released in response to gluten or certain bacteria
Systemic Lupus Erythematosus (SLE): natural treatment
- Anti-inflammatory diet
- Supplements: vitamin D3, antioxidants, alpha lipoic acid, EFAs.
- Herbs, acupuncture and homeopathy.
- Manual therapy for joint pain.
- Stress reduction, e.g. meditation, breathing exercises, etc.
Rheumatoid Arthritis: natural treatment
- Nutrition: anti-inflammatory and reducing intestinal permeability: increase antioxidants,
- Mediterranean diet / increase omega-3, Vit D3
- Herbs for pain and inflammation and immune modulation: Turmeric, Boswellia, Devil’s Claw.
- Homeopathy (e.g. Rhus tox) and acupuncture.
Ankylosing Spondylitis: natural treatment
Nutrition (remove pathogenic
organisms / elimination diet / increase
vitamin D3 and antioxidants)
Herbs (antiinflammatory)
Homeopathy; acupuncture
Manual therapies to help prevent kyphosis
