Autoimmune Disease Flashcards
What are autoimmune diseases?
Conditions where the immune system attacks the body’s own tissues.
List common autoimmune diseases.
-Rheumatoid arthritis
-lupus
-inflammatory bowel disease (IBD)
-Hashimoto’s thyroiditis
-Graves’ disease
-psoriasis.
List less common autoimmune diseases seen in physical therapy.
-Multiple sclerosis
-Guillain-Barre syndrome
-myasthenia gravis
What are the possible causes of autoimmune diseases?
Genetics: Linked to immunoglobulin, T-cell receptor, and MHC complex genes.
Environmental Factors: Exposure to viruses, bacteria, or toxins.
Hormonal Factors: Hormonal changes, especially in women, may play a role.
Define Guillain-Barré syndrome (GBS)
An acute paralytic polyneuropathy affecting the peripheral nervous system.
What is the pathophysiology of GBS?
Caused by molecular mimicry
What is molecular mimicry?
It is a process where B cells produce antibodies against antigens from a triggering pathogen. These antibodies mistakenly recognize and bind to similar proteins on peripheral neurons, potentially damaging the myelin sheath or the nerve axon.
What is the clinical presentation of GBS?
-Symptoms usually start within four
weeks of what is thought as a triggering
infection from either a virus or bacteria
(e.g. infection with “campylobacter”
which is a type of bacteria found in
undercooked poultry).
-They begin in the feet and progress
upward (ascending).
-Symptoms peak within 2-4 weeks. Then,
there is a recovery period that can last
months to years.
Characteristic features of GBS
• Symmetrical ascending weakness
• Reduced reflexes
• Peripheral loss of sensation
• Neuropathic pain
• May progress to cranial nerves and
cause facial paralysis
• Autonomic dysfunction may cause
urinary retention or heart arrhythmias
What is the primary diagnostic tool for GBS?
Brighton criteria, which helps diagnose GBS and help distinguish between low-risk and high-risk patients.
Brighton criteria is supported by further investigations such as?
-Nerve conduction study (NCS) : Reduced
nerve signal
-Lumbar puncture : To test cerebrospinal fluid
protein count → High protein level with
normal cell count
What is the leading cause of death in patients with GBS?
Pulmonary embolism due to immobilization
How is GBS managed?
-First-line treatment: IV immunoglobulins (IVIG).
• Alternative: Plasmapheresis.
-Supportive care: Pain management, physical therapy, and VTE prophylaxis (anticoagulant).
What is prognosis of GBS usually like?
-Recovery can take months to years. Patients can continue regaining function five years after
onset.
-Most patients make a full recovery or are left with minor symptoms.
-Some are left with significant disability.
In GBS mortality is approximately 5% mainly due to?
respiratory or cardiovascular complications.
Define myasthenia gravis.
An autoimmune condition affecting the neuromuscular junction.
MG affects men and women at different ages, what is the typical age for each?
affecting women under 40 and men over 60
There is a strong link between myasthenia Gravis
and what disease?
thymomas (thymus gland tumors)
What is the pathophysiology of MG?
acetylcholine receptor (AChR) antibodies are found. These antibodies bind to the postsynaptic acetylcholine receptors, blocking them and preventing stimulation by acetylcholine.
What is the effect of activity vs rest in patients with MG?
-The more the receptors are used during muscle activity, the more they become blocked. There is less effective stimulation of the muscle with
increased activity.
-With rest, the receptors are cleared, and the
symptoms improve.
Antibodies cause cell damage at the postsynaptic
membrane, further worsening symptoms of MG, why?
Because these antibodies also activate the complement system within the neuromuscular junction
Other than ACh receptor antibodies, what antibodies also cause MG?
-Muscle-specific kinase (MuSK) antibodies
-Low-density lipoprotein receptor-related protein 4 (LRP4) antibodies
Describe the clinical presentation of patients with MG
-Symptoms vary dramatically between patients, ranging from mild to life-threateningly
severe.
-The critical feature is weakness that worsens with muscle use and improves with rest.
-Symptoms are typically best in the morning and worst at the end of the day.
What are the characteristic features of MG?
-Proximal muscle weakness (limb and small muscles of the head and neck
-diplopia
-ptosis
-dysphagia
-dysarthria
-fatigue
How is MG diagnosed?
eliciting fatigue in specific muscles:
• Repeated blinking will exacerbate ptosis
• Prolonged upward gazing will exacerbate diplopia on further testing
• Repeated abduction of one arm 20 times will result in unilateral weakness when comparing both sides
Further examination for MG includes?
-Checking for a thymectomy scar
-Testing the forced vital capacity (FVC)
Investigation to diagnose MG includes antibody testing to look for…
-AChR antibodies (around 85%)
-MuSK antibodies (less than 10%)
-LRP4 antibodies (less than 5%)
Looking for thymoma in patients with MG is done through…
CT and MRI of the thymus
What tool is used to clear any doubt about MG diagnoses?
The edrophonium test
How is MG managed?
-Thymectomy for thymoma.
-Supportive care and rehabilitation.
Although MG prognosis is positive (treatment only improves symptoms, not cure the disease), some cases could be life threatening, when is that?
an acute worsening of symptoms affecting the respiratory system.
How does physical therapy help in autoimmune diseases?
-Pain Management: Massage, mobilization, heat/cold therapy.
-Improving Range of Motion: Stretching and ROM exercises.
-Muscle Strength & Endurance: Aerobic and strength exercises.
-Balance & Coordination: Task-oriented exercises.
-Fatigue Management: Energy conservation techniques.
What challenges do physical therapists face with autoimmune patients?
-Fluctuating symptoms require adaptable plans.
-Fatigue management through balanced rehab and rest.
-Planning rehab around medication times.
-pain management
