3: Rheumatic conditions Flashcards
Th17
located in skin and mucosa
produce inflammatory cytokines against pathogens
dysregulation assoc with Auto Immune
Aryl HydroC activation
stimulates CYP450 stimulate Th17 or Treg
NF Kappa B
TF chronically active in inflammatory dz
Inhibitors of Th17
Vit D, Retinoic acid
Up-regulators of Th17
salt! TNFa
etiology of RA
begins in the lungs (pollutants activate aryl hydrocarbons!)
RA review
inflammatory, polyarthropathy
cutaneous nodules
vasculitis
cardiopulmonary complications
RA immunipathopys
AutoAbs to citrullinated peptides (anti CCP)
Th1, Th9, Th17
Treg suppression
leukocytes and fibroblast-like-synoviocytes
formation of pannus tissue
ROS mediated bone dstrxn
RA Risk Factors
cigarette smoking: AhR ligands-PAH upregulates inflammatory cytokines Family Hx Female Stress Coffee >4cups ? Obesity ?
RA Prevention
Dietary antioxidants
Antiox supplements (Vit C, Zinc)
Vit D
RA potential for malnutrition
hands greatly affected, greatly limits food choices
malabsorption dt inflammation, villous atrophy
RA Nutritional Tx
Elimination Diet: NO corn, wheat, pork, oranges, milk, oats, rye, egg, beef, coffee, nightshades (?) Veg Diet (low in aracadonic acid) Mediterranean Diet (low in aracadonic acid)
RA Nutritional Tx: Fasting
reduces sx during the fast: ALL food has some degree of antigenicity
periodic (multiple consecutive days)
intermittent (alternate days 1-2/week)
fasting followed by veg diet
RA Supplements: Vit A
promotes Treg and suppresses Th17
monitor for toxicity (dry skin, anorexia, fatigue, HA, osteopenia, psych, arthralgia, bone pain)
Maillard Reaction
Protein + sugar + heat (>285° F)
Produces aromatic/flavorful compounds–Some of which are pro-inflammatory, immune-sensitizing, and/or carcinogenic
RA Supplements: Vit D
\prevents progression, reduces dendritic cells and immunoglobulins, reduces Th17 differentiation, IL 17 and IL 22; prevention of bone loss in steroid use
RA Supplements: EGCG and ALA
decrease IL1B, IL6, IL8, TNFa
RA Supplements: omega 3 and olive oil FAs
decreased tender jt count and AM stiffness
reduce MMP3, inflammatory cytokines
EVOO: monounsat fat, good for CV health
RA Supplements: gamma linolenic (borage, EPO)
PGE 1 synthesis facilitated anti-inflammatory
RA Supplements: virgin coconut
reduces inflammatory cytokines, CRP, WBCs
RA Supplements: Se and Vit E
? maybe helpful
RA Supplements: Zn
cofactor for SOD
deficiency common in RA
? maybe helpful
RA Supplements: Misc
Mn: cofactor for SOD,
Cu: cofactor for SOD, bracelets may help
Vit C: increases SOD activity, reduces histamine
RA Supplements: B vitamins
Pantothenic acid and pyridoxine, both found to be low in RA pts
RA Supplements: Garlic
reduces IL6, IL8, TNFa
Juvenile RA Tx Modifications
modify dose based on age/weight
increase protein, consider Zn supplementation
Psoratic Arthritis: Nutritional Tx
Elimination Diet (esp gluten, dairy, beef) higher prevalence of celiac dz in pts with PsA
Psoriatic Arthritis
Enthesitis Dactylitis Anterior uveitis/iritis Exacerbation of skin/nail psoriasis lesions Th17 over-population IL-23, IL-22, IL-17, IL-6 predominat
Ankylosing Spondylitis
begins at SI joints; Peripheral jt ~20% of patients
Extra-articular manifestations: Iritis, Cardiopulmonary complications, Renal disease,
~90% of AS patients are HLA-B27 positive
AS: Nutritional Supplements
Allicin: Reduced IL-6, IL-8, TNF-α with Inhibition of HLA-B27 protein translation
Polymyositis (PM) and Dermatomyositis (DM)
Inflammatory autoimmune conditions affecting skeletal muscle (PM and DM) and skin (DM)
Th1 and Th17 excess, elevated Th17:Treg, elevated IL17 and Il6
PM and DM: Nutritional Tx
Elimination diet!! Esp gluten
Creatine monohydrate
vit E
vit D
Scleroderma
Skin and visceral fibrosing dz CREST: Calcinosis cutis Raynaud phenomenon Esophageal dysmotility Sclerodactyly Telangiectasia
Scleroderma Risk Factors
Silica dust Organic solvents Paint thinner/remover Heavy metals Plastics manufacturing Iatrogenic, eg antiretrovirals Family Hx
Scleroderma Nutritional Tx
caution with fiber
SAMe
ALA
Green tea/EGCG
Sjogren syndrome
AI against exocrine glands Dry eyes (keratoconjunctivitis sicca) Dry mouth (xerostomia)
Sjogren: Nutritional Tx
Elimination diet– Gluten, Dairy
Common to have def dt hypochlorohydria: iron, B12, folate
Systemic Lupus Erythematosus pathophys
Auto Abs to: Nuclear antigens Cell membrane antigens Phospholipid-associated antigens Blood cells Endothelial cells Nervous tissue Plasma proteins Matrix/ECM proteins
Reduced clearance of apoptotic cells
Induction of T follicular helper (Tfh) and Th17 cell differentiation
Elevated IL-17, IL-23
Generally elevated inflammatory cytokines
SLE sxs
Malar (“butterfly”) rash Renal disease Pulmonary disease Arthritis Cardiovascular disease (rapidly progressive atherosclerosis) Photosensitivity Weight loss Neuropsychiatric involvement
SLE Treatment
Xenobiotic avoidance/depuration (pollutants, drugs, environmental exposures)
SLE Nutritional Tx
elimination diet flax seeds omega 3 fatty acids Brassicas vitamin A vitamin D
Gout Pathophys
Hyperuricemia usually present
Overproduction via xanthine oxidase/excess substrate (purines
Under excretion in urine
Gout Nutritional Tx AVOID
Low purine diet (avoid alcohol, esp beer)
Limit animal proteins, yeast, beans
Avoid spirulina, chlorella, royal jelly, fructose, sugar
Gout Nutritional Tx
Protective effect: dairy, coffee, cherry juice
Vit C: gradually increase dose d/t migration of uric acid
Folic acid
Weight Loss (gradual)
Do NOT need to limit protein
ANTI-Inflammatory Diet
Osteoathritis Pathophys
Degenerative arthropathy: knee, hip, spine, hands
both wear and tear AND inflammatory process
chondrocyte senescence accelerated by cytokines, ROS, AGEs
OA Risk Factors
Age > 55 yrs
Obesity
Diet high in refined foods
OA Nutritional Tx
Weight loss: >5.1 % improves function and pain; (adipokines detection in synovial fluid!)
Elimination Diet: plus no nightshades (and citrus)
OA Nutritional supplements
Glucosamine sulfate: must take high enough dose!! (1500mg)
Chondroitin sulfate: polysaccharide component of proteoglycans
Niacinamide: decreased dz progression, increase jt mobility, but increase in liver enzymes :{
MSM
SAMe
Vit C: reduces risk of cartilage loss, synergy with vit E
Vit D
Pantothenic Acid (getting this in multi is fine)
Vit K: only important if deficient
(Also Vit A, Fe, Vit E, B6, Zn, Cu, Boron)
