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Y2 LCRS Musc Fwong HR > 3. Pathogenesis of autoimmune disease > Flashcards

3. Pathogenesis of autoimmune disease Flashcards

1
Q

Upon which cells is HLA 1 and 2 presented?

A

HLA 1 = all cells

HLA 2 = APCs

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2
Q

What sort of antigens are presented by MHC 1 and 2

A 
MHC1 = endogenous
MHC2 = exogenous
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3
Q

What class of T cells is involved in recognising MHC1 and 2?

A 
MHC1 = CD8+
MHC2 = CD4+
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4
Q

Recall the general pathogenesis of AID

A

Ag binds HLA to trigger disease

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5
Q

Recall the HLA association of anklyosing spondylitis

A

HLA-B27

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6
Q

Recall the HLA association of rheumatoid arthritis

A

HLA-DR4

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7
Q

Recall the HLA association of SLE

A

HLA-DR3

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8
Q

What class of HLA are HLA-B molecules?

A

Class 1

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9
Q

What class of HLA are HLA-DR molecules?

A

Class 2

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10
Q

What sort of auto-antibody is associated with rheumatoid arthritis?

A

Anti-CCP

RF

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11
Q

What is ankylosing spondylitis?

A

Chronic spinal inflammation, leading to spinal fusion and deformity

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12
Q

What is enthesitis?

A

Inflammation where a tendon inserts into the bone

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13
Q

What antibodies are associated with ankyloing spondylitis?

A

None - it is seronegative

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14
Q

Recall 2 extra-articular associations of ankylosing spondylitis

A

Psoriatic arthritis

IBD + enterpathic synovitis

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15
Q

What if the main form of inflammation in ankylosing spondylitis?

A

Enthesitis

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16
Q

What is the main driver of inflammation in SLE?

A

Immune complexes

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17
Q

Which autoantibodies are present in SLE?

A

ANA

anti-dsDNA

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18
Q

Where does SLE cause inflammation?

A

Connective tissue

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19
Q

Recall the site of production and effect(s) of gamma-IFN

A

T cells:

Activates macrophages

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20
Q

Recall the site of production and effect(s) of IL1

A

Macrophages:
Activates T cells
Pyretic
Pro-inflammatory

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21
Q

Recall the site of production and effect(s) of IL2

A

T cells:

Activates T and B cells

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22
Q

Recall the site of production and effect(s) of IL6

A

T cells:

Activates B cells

23
Q

Recall the site of production and effect(s) of TNF alpha

A

Similar to IL1 but more destructive
Activates T cells
Pyretic
Pro-inflammatory

24
Q

Which cytokine is particularly important for bone destruction in rheumatoid arthritis?

25
By what sort of cells is RANK-L produced?
T cells | Synovial fibroblasts
26
What is the effect of RANK-L binding to RANK?
Osteoclast activation
27
What is the most important inflammatory mediator in rheumatoid arthritis?
TNF-alpha
28
What is the effect of TNF-alpha on bone?
It activates macrophages, which damage bone and cartilage
29
Recall 2 treatments for rheumatoid arthritis?
Anti-TNF-alpha | PG blockade
30
How do glucocorticoids affect the prostaglandin production pathway?
Inhibit PLA2, the enzyme that liberates arachdionic acid from cell membranes
31
Recall a virus that may be associated with SLE development
EBV
32
Summarise the known pathogenesis of SLE
Apoptosis Nuclear antigens translocated to cell surface ANA produced Clearance impaired = stimulus to mount immune response--> B cell-auto-immunity Complement and cytokine activation Tissue damage
33
What class of Ig is ANA
IgG
34
Recall 3 specific non-sinister features of SLE
"Butterfly" erythematous rash Arthralgia Raynaud's
35
Recall 2 more sinister features of SLE
Vital organ inflammation | Accelerated atherosclerosis
36
Recall 4 initial features of SLE
Weight loss Fatigue Fever Lymphadenopathy
37
Describe the pattern of ANA staining in SLE
Homogenous nuclear staining
38
Recall 3 specific antibodies for SLE diagnosis, and which of these is definitively diagnostic
Anti-dsDNA Anti-Smith (def) Anti-Ro
39
Recall one specific danger associated with Anti-Ro antbodies
Can cross placenta --> heart block in foetus
40
How can you test the activity level of SLE
Complement consumption
41
How does a complement test differ in rheumatoid arthritis and SLE?
In RA, complement = high | In SLE, complement CONSUMPTION is high so would be low
42
Recall 2 haematological conditions that SLE patients are at high risk of contracting
AIHA | Thrombocytopenia
43
Why is a urine dipstick test used in SLE diagnosis?
Looking for proteinuria to assess renal inflammation
44
Recall 2 important non-antibody lab markers used in SLE diagnosis
ESR is high whilst CRP is low
45
How is mild SLE treated?
Paracetemol and NSAID
46
How is mild SLE defined?
Only joint and skin involvement
47
how is moderate SLE defined?
More than just skin and joint involvement - add in inflammation of heard/lungs/kidney: Pleuritis Pericarditis Nephritis
48
Recall the management of moderate SLE
Paracetemol and NSAID like mild, in addition: Corticosteroid: suppresses disease, titre this down as disease is managed Immunological therapy: azothioprine - these have a synergistic effect with steroids
49
How is severe SLE defined?
Sever inflammation in vital organs
50
Recall 4 features of severe SLE
Myocarditis Severe nephritis AIHA/ thrombocytopenia
51
Recall 2 approaches to treatment of severe SLE
Immunomodulatory drugs | Biologics
52
Recall an example of an immunomodulatory therapy used in severe SLE and one advantage and disadvantage of this drug
Mycophenalate mofetil Ad: doesn't impair fertility like cyclophosphamide Dis: Doesn't protect renal function so well
53
Recall an example of an immunoodulatory therapy used in moderate SLE, and one drawback of its use
Cyclophosphamide | Impairs fertility

Y2 LCRS Musc Fwong HR (8 decks)

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