AIAI disease 2 Flashcards
Explain aetiology of Graves
Production of IgG antibodies
Antibodies bind to TSH receptor
This stimulates production of thyroid hormones> excess thyroid hormone production
What is the evidence for Graves?
Antibodies stimulate thymocytes in vitro
Passive transfer of IgG from patients to rats produces the same symptoms
Babies born to mothers with Graves show transient hyperthyroidism
What type of hypersensitivity reaction is Graves?
Type II
What happens in the thyroid in Hashimoto’s ?
It becomes infiltrated with B and T cells > enlarged > goitre
What antibodies act in Hashimoto’s?
Anti-TPO antibodies
Anti-thyroglobulin antibodies
What time of hypersensitivity reaction is Hashimoto’s?
Type II, IV
What antibodies predate T1DM?
Anti-islet cell
anti-insulin
Anti-GAD
Anti-IA2
What did experiments show in mice for T1DM?
The non-obese diabetes mouse model showed CD( T cell infiltration of pancreas
CDH T cells bind to peptides presented by MHC Class I on beta cells of pancreas
Does detection of antibodies play a role in diagnosis of T1DM?
NO
What occurs in pernicious anaemia?
Antibodies are made against intrinsic factor
This leads to failure of absorption of vitamin B12
What clinical conditions does B12 deficiency lead to?
Subacute degeneration of spinal cord
Peripheral neuropathy
Optic neuropathy
What antibodies are used in diagnosis of pernicious anaemia?
gastric parietal cell antibodies
intrinsic factor antibodies
What antibodies to patients display in myasthenia gravis?
Anti-acetylcholine receptor antibodies
Antibodies against nicotinic acetylcholine receptor > leads to failure in depolarisation
What test confirms dx of myasthenia gravis?
TENSILON test
What does the tensilon test involve?
Administer short acting anti cholinesterase e.g. edrophonium bromide
This will cause rapid improvement in symptoms
What type of hypersensitivity is MG?
Type II
What antibodies are present in good pastures?
Anti-glomerular basement membrane antibodies
What is the genetic predisposition of RA?
HLA DR1, HLA DR4
PTPN22
What antibodies are present in RA?
Anti-cyclic citrullinated peptide antibodies Rheumatoid factors (low sensitivity)
What are environmental factors associated with RA?
Smoking > erosive disease, due to increased citrullination
Gum infection with porphyromonas gingivitis
What occurs in the joint in RA?
Inflamed synovial tissue forms a PANNUS that overlays and invades articular cartilage
What are the genetic predispositions in lupus?
Abnormalities in clearing apoptotic cells
Abnormalities in cell activation
B cell hyperactivity, loss of tolerance
Antibodies directed at IC proteins
What is the triad in antiphospholipid syndrome?
recurrent thrombosis (arterial/venous)
recurrent miscarriage
thrombocytopenia
What are the three major antibody tests in antiphospholipid syndrome?
Anti-cardiolipin
Lupus anticoagulant
AntiB2 glycoprotein 1 antibody
What immune cells predominate in inflammation in systemic sclerosis ?
Th2, Th17
What polymorphisms are responsible for activation of fibroblasts > fibrosis in systemic sclerosis’
- T1 collagen alpha 2 chains AND Fibrillin 1
- TGF beta
What are symptoms of limited cutaneous systemic sclerosis?
CREST
Calcinosis Raynaud's phenomenon Esophageal dysmotility Sclerodactyly Telangiectasia
What are symptoms of Diffuse Cutaneous Systemic Sclerosis?
Symptoms extend beyond forearms CREST + GI disease Interstitial pulmonary disease Kidney scleroderma, renal cyst
What antibody is responsible for diagnosis of limited cutaneous scleroderma
anti-centromere antibody
what antibodies aree responsible for diagnosis of diffuse cutaneous scleroderma
anti-topoisomerase, Scl70, RNA Pol I,II,III, Fibrillarin autoantiboidies
what antibodies are responsible for Sjogrens
Anti-Ro, anti-La
what are symptoms of Sjogrens
dry mouth (xerostermia) dry eyes (keratoconjunctivitis siccA) dry nose and skin
what test can you use to measure production of tears in Sjogreens
Schirmers
what does IPEX stand for
Immune dysregulation
Polyendocrinopatyhy
Enterpathjy
X linkd
what are clinical features in IPEX
eczema /dermatitis
naail dystrophy
AI skin condition (alopecia universalis, bullous pemphigoing
What are antibodies for coeliaca
IgA EMA (anti endomysial antibodies) IgA TGT (anti transglutaminase antibodies) IgG anti gliadin aantibodies
what is the skin condition with coeliacs
Dermatitis herpetiformis
what antibody disappears with exclusion diet in coeliacs
anti endomysial antibodie
WHat HLA mutations are associated with coeliac
HLA DQ2, DQ8
DQ2.5 most common
Two Eight or not to eat?
what kind of staining measures anti dsDNA in SLE
Homogeneous stain
How good is anti-dsDNA in SLE
VERY GOOD - HIGHLY SPECIFIC present in 70% of SLE patients
what are high titres of anti-dsDNA associated with
SEVERE SLE
incl renal / CNS involvement
How do you confirm anti dsDNA
ELISA
What is the complement profile for inactive SLE
Normal C3, Normal C4
what is the complement profile for active SLE
Normal C3, LOW C4
What is the complement profile for severe active SLE
LOW C3 and LOW C4
what is a speckled pattern on homegeneous staining inficative of
antivbodies to EXTRACTABLE NUCLEAR ANTIGENS ENA 4 (so ribonucleoproteins, eg, Ro, La, Dm, U1RNP)
