Autoimmune Disorders Flashcards
Cause of general autoimmune disorders
- immune mechanism is directed against self antigens
Etiologic of general autoimmune disorders
- acquired diseases, cause may not be determined
Pathogenesis of general autoimmune disorders
- disruption of immunoregulatory mechanism
Treatment for general autoimmune disorders
- maintain balance between adequate suppression & maintenance of immune function as well as symptom relief
Define lupus erthematosus
- chronic inflammatory autoimmune disorder with highly variable clinical presentation
- idiopathic
Define discoid lupus erthematosis (DLE)
- affects only the skin
- rare
Define systemic lupus erthematosis (SLE)
- can affect any organ or system of the body, often in different combinations
Risk factors for lupus
- immunological, environmental, hormonal, & genetic factors
- physical & mental stressors
- viral infections
- sunlight or UV exposure
- abnormal estrogen metabolism
Pathology of lupus
- autoantibody production
- inflammation
- vascular abnormalities
Clinical manifestations of lupus
- fatigue, fever, malaise, & weight loss
- arthralgia, arthropathy, myalgia, arthritis, & avascular necrosis
- malar/butterfly rash, photosensitivity, discoid lesions, vasculitis, necrosis, & gangrene
- acute or chronic renal failure & acute nephritic disease
- seizure, psychosis, headaches, irritability, & depression
- pleurisy, pleural effusion, pneumonitis, pulmonary hypertension, & interstitial lung disease
- nausea, dyspepsia, abdominal pain
Treatment for lupus
- NSAIDS for muscle pains & inflammation
- Methotrexate for early preservation of bone & cardio protection
- Antimalarials for dermatological, arthritic, & renal symptoms
- Immune-modulating drugs
- Corticosteroids
- Cytotoxins
Rehab management for lupus
- focus on strength, endurance, activity pacing, & energy conservation
Prognosis of lupus
- no way to prevent
- no cure only treatment of symptoms
- prognosis improves with early detection & intervention
Define fibromyalgia
- chronic widespread pain with hyperalgesia to pressure pain
- can occur as a result of other inflammatory conditions, metabolic dysfunctions, or cancer
Describe chronic fatigue syndrome (CFS)
- it’s an early form of fibromyalgia
- is associated with viral infections & constitutional symptoms
Risk factors for fibromyalgia
- prolonged anxiety
- emotional stress
- trauma
- rapid steroid withdrawal
- hypothyroidism
- viral & non-viral infections
- exposure to tobacco
Possible causes of fibromyalgia
- diet, viral origin, & sleep disorder
- occupational, seasonal, or environmental influences
- psychologic distress
- adverse childhood experiences, including sexual abuse
- familial or hereditary link
Clinical manifestations of fibromyalgia
- muscle pain, often described as aching or burning
- diffuse pain or tender points
- sleep disturbances = fatigue & exhaustion
Treatment for fibromyalgia
- stress management
- acupuncture
- yoga
- nutrition
- lifestyle training
- coping strategies
- activity modification
- energy conservation
- psychotherapy
- medications
Define ankylosing spondylitis
- inflammatory disease primarily of the axial skeleton, SI joints, apophyseal joints, costovertebral joints, & intervertebral disk articulations
Pathology of ankylosing spondylitis
- disruption of junction of tendon, ligament, cartilage, or synovium with bone
- reactive bone formation as part of repair process
- progressive ossification
Clinical manifestations of ankylosing spondylitis
- insidious onset of SI joint pain for >3 months
- patient may complain of lower back pain, stiffness, & fatigue
- pain begins as a dull ache and become more severe & constant
- persistent inflammatory symptoms of tendons & ligaments
- early loss of lumbar lordosis & increased thoracic kyphosis
Complications of ankylosing spondylitis
- osteoporosis
- axial subluxation
- spinal stenosis
- flexion contractures
- rigid gait
- crouched stance
Rehab management for ankylosing spondylitis
- maintain spinal extension
- breathing
- postural training
- endurance
- gait training
Describe polymyalgia rheumatica (PMR)
- pain in the muscles
- diffuse pain & stiffness, pelvic & shoulder girdles mostly
- initial symptoms are subtle & lead to bursitis
- usually resolves on its own in 5 years
- with progression ADLs & transfers become more difficult
What other disease can increase your chances of developing polymyalgia rheumatica
- giant cell arthritis which is the inflammation of the arteries in head & neck
Suspected factors for polymyalgia rheumatica
- genetics
- infection
- autoimmune dysfunction
Pathogenesis of polymyalgia rheumatica
- joint inflammation
- bursitis
- hip synovitis
- no other histologic changes within muscle
- MRI & ultrasound
Elevation in what lab tests will indicate inflammation
- elevated ESR
- elevated C-reactive protein
Clinical manifestations of polymyalgia rheumatica
- onset could be insidious or abrupt
- may be unilateral or bilateral
- pain & stiffness but not muscle weakness lasting 1 hour in the A.M.
- flu like symptoms & depression
- ADLs limited
Treatment of polymyalgia rheumatica
- corticosteroids: prednisone
- may require maintain therapy up to 5 years
Rehab management for polymyalgia rheumatica
- pain control
- ROM
- management of bursitis/tendinitis
- correction of muscle imbalance
- patient education
Describe scleroderma
- generalized connective tissue disorder characterized by immune dysregulation, microangiopathy, fibrosis of skin, synovium, & vital organs
- excessive amounts of collagen are placed in the tissue
- chronic disease lasting months to years to lifetime
Define limited cutaneous systemic scleroderma
- skin thickening of hands & face, that does not progress proximal to elbow/knee
Define diffuse cutaneous systemic scleroderma
- extends proximally to elbow/knee, less common, more debilitating
Define systemic sclerosis sine systemic scleroderma
- fibrosis of internal organs without skin manifestations
Define localized scleroderma
- affects skin in 1 or more areas, without visceral organ effects, not to confuse with limited
Pathogenesis of scleroderma
- triggered by bacteria, autoimmune, chemicals from occupational exposure
- widespread small vessel vasculopathy & fibrosis
- persistent deposition of collagen
- microvascular changes
Clinical manifestations of scleroderma
- pitting edema
- bilateral & symmetrical involvement
- Raynaud’s phenomenon
- stiff, bound down skin
- decreased joint ROM
- mask-like facial features
- calcium deposits
- nephritis
- GI dysfunction
- CNS disorders
Define edematous stage (1st stage) of scleroderma
- bilateral edema of fingers & hands that progress to the forearms, arms, upper chest, abdomen, & back
Define sclerotic stage (2nd stage) of scleroderma
- edema is replaced by thick hard skin that becomes tight, smooth, waxy, or shinny in appearance
Define atrophic stage (3rd stage) of scleroderma
- particularly over joints at sites of flexion contractures, thinning of skin = ulcerations
Diagnosis of scleroderma
- skin biopsy
- blood tests: increased ESR, + ANA, & decreased WBC count
Rehab management of scleroderma
- joint protection
- ROM
- education
- skin & wound care
- ADL’s
