Autoimmune Flashcards
Autoimmune Diseases| Organ-Specific Diseases Mediated by Antibodies
•Autoimmune hemolytic anemia
•Autoimmune thrombocytopenia
•Autoimmune atrophic gastritis or perniculous anemia
•Myasthenia gravis
•Graves’ disease
•Goodpasture’s syndrome
Autoimmune Diseases| Systemic Diseases Mediated by Antibodies
Systemic lupus erythematosus
Autoimmune Diseases| Organ-Specific Diseases Mediated by T Cells
Type 1 diabetes| Multiple sclerosis
Autoimmune Diseases| Systemic Diseases Mediated by T Cells
Rheumatoid arthritis
Systemic sclerosis (scleroderma)
Sjorgen syndrome
Autoimmune Diseases| Organ-Specific Diseases Postulated to be Autoimmune
Inflammatory bowel diseases (Crohn’s disease or ulcerative colitis)Primary biliary cholangitisAutoimmune (chronic active) hepatitis
Autoimmune Diseases| Systemic Diseases Postulated to be Autoimmune
Polyarteritis nodosa| Inflammatory myopathies
Lupus
Systemic disease mediated by antibodies
multi-systemic autoimmune disease characterized by presence autoreactive B & T cells & production broad heterogenous group auto-antibodies
Lupus Pathogenesis
•Women 15-44yo
•AfricanAmerican, Asian Americans, Hispanic/Latinos, Native Americans, or Pacific Islanders
•50 genes associated w/ SLEUV •light,
•infection,
•virus,
•stress
•Auto-antibodies production w/o regulation
•Immune activation T & B cells hyperactive & innate immune systems programmed towards inflammation eventually leading to tissue damage & clinical disease manifestations
Lupus Diagnosis
CBCAntibody tests- ANA- Anti dsDNA antibodyComplement testBlood clotting testsUrine testBiopsies
Lupus Classification
•Malar (butterfly) rash
•Photosensitivity
•Oral or nasopharyngeal ulcers
•Discoid (thick, scaly) rash
•Renal disorders
(pleurisy, pericarditis)
•Neurologic disorders
•Hematological disorders
•Immunological disorders
•Non-erosive arthritis at least 2 peripheral joints
•Presence of• antinuclear antibody (ANA)```
Lupus Types
•Systemic lupus erythematosus
•Drug-induced lupus erythematosus (hydralazine, procainamide, isoniazid)
•Cutaneous lupus erythematosus - caused by maternal antibodies, born w/ skin rash, liver problems, & low blood counts, congenital heart block
•Neonatal lupus-passive transfer of autoantibodies from the mother to the fetus results in fetal and neonatal disease.
SLE S/S
CNS - vasculitis, anxiety, depression, psychosis, seizures, stroke
CV - pericarditis, pericardial effusions, CHF, HTN, mitral/aortic regurgitation, conduction defects, thrombocytopenia, anemia, leukopenia, antiphospholipid syndrome (acquired hypercoagulability - embolism)
Pulmonary - pleural effusions, restrictive disease, atelectasis
Airway - mucosal ulceration, cricoarytenoid arthritis, recurrent laryngeal nerve palsy
Renal - glomerular nephritis, proteinuria, hypoalbuminemia, hematuria, renal failure
Muskuliskeletal - arthritis, avascular necrosis d/t steroid use
Lupus Treatment
Tylenol NSAIDsImmunosuppressantsCorticosteroidAntimalarialAnticoagulantsMonoclonal antibodiesRepository corticotropin injections
Blah
Blah
Rheumatoid Arthritis
•Onset 25-55yo
•2-3x more prevalent in women
•Environmental and genetic factors
(genetic factors 50%)
Viral/bacterial infection
Osteoarthritis
Degenerative disease
Morning stiffness lasting <30 min
Heberdens nodes
Asymmetrical cartilage loss
Rheumatoid Arthritis S/S
Autoimmune disease
Morning stiffness lasting >30min
Extra articulation involvement
Symmetrical
- vary in severity (S/S come & go)Inflamed synovium```
Smaller joints involved 1st (hands, feet, wrists) & progresses to ankles, hips, shouldersInflamed synovial joint membraneRapid division & cell growth w/in jointPro-inflammatory cytokinesRelease osteolytic enzymes, collagenases, proteasesNerve entrapment - carpal tunnel syndromeTMJ - synovitis 45-75% involvement
Atlantoaxial Instability
C1-C2 (atlas-axis) involvementAtlanto-odontoid separation → neurologic damageAtlantoaxial subluxation → impairs vertebral artery blood flow
Cricoarytenoid Joint
•26-86% patients w/ severe Present w/o clinical symptoms
•Vocal cord nodules or polyps
•Hoarseness
•Pain w/ swallowing
•Stridor
•Dyspnea
RA Treatment
Disease modifying anti-rheumatic drugs DMARDSNon-biologicAnti-metabolite- Methotrexate (Rheumatrex)- Sulfasalazine- AzathioprineBiologic TNF inhibitors- Etanercept (Enbrel)- Adalimumab (Humira)- Infliximab (Remicade)Interleukin-1 receptor agonists- Leflunomide (Arava)Anti-CD20 monoclonal antibody- Rituximab (Rituxan)
RA Anesthetic Considerations
Medications - NSAIDs & corticosteroidsAirway - TMJ, cervical spine, cricoarytenoid jointPositioning - padding to prevent further joint damageSpinal anesthesia - sensory & ↓CSF
Scleroderma
“Hard skin”
•Inflammation
•Vascular sclerosis
•Skin & viscera fibrosis with injury to vascular endothelium results in protein leakage into interstitial space
•Collagen production not slowed down & deposited throughout body
Scleroderma Causes
UnknownCollagen vascular disease & autoimmune characteristics
20-40yoWomen
Accelerated by pregnancy
CREST syndrome- Calcinoses Ca2+ deposits- Raynaud’s phenomenon- Esophageal hypomotility- Sclerodactyly (thickened/tight skin)- Telangiectasia (dilated capillaries)```
Scleroderma S/S
CNS - peripheral & cranial neuropathies d/t nerve compression by thickened connective tissue, trigeminal neuralgia, dry eyes
Musculoskeletal- thickened skin, diffuse edema, contractures, skeletal muscle myopathy, arthritis & limited joint mobility, avascular necrosis
Vascular- coronary arteries & conduction system sclerosis, replace cardiac tissues w/ fibrous tissue, systemic & pulmonary HTN, pericarditis & pericardial effusion, intermittent vasospasm, Raynaud
Respiratory- diffuse interstitial pulmonary fibrosis 80% patients, arterial hypoxemia 2° ↓diffusion capacity, ↓pulmonary compliance
GI - dry oral mucosa, progressive GI tract fibrosis, dysphagia, hypomotility, ↓LES tone → aspiration risk, malabsorption vitamin K deficiency (coagulopathies)
Renal - ↓renal blood flow → systemic HTN, renal artery stenosis d/t arteriolar intimal proliferation
