Autoimmune Disorders Flashcards
conditions in which damage to organs or tissues results from the
presence of autoantibody or autoreactive cells?
Autoimmune diseases
Great majority of undifferentiated lymphocytes that are processed through the thymus do not survive
Central tolerance
Maintained by a delicate balance between the T helper cell type 1 (Th1) and T helper cell type 2 (Th2) populations
Peripheral tolerance
refers to the fact that many individual viral or bacterial agents contain antigens that closely resemble self-antigens
Molecular mimicry
have been implicated as primary mediators of autoimmune disease, because they release proinflammatory cytokines
Th1 cells
reaction to foreign antigens is typically a?
Th2 response
play a central role in maintaining this balance and eliminating harmful autoimmune responses
T cells (Tregs)
Abnormal expression or function of key signaling molecules, dysregulation of cytokines, and changes in B-cell developmental subsets
Polyclonal B-cell activation
May be enhanced by organisms such as gram-negative bacteria and several viruses, including cytomegalovirus and Epstein-Barr virus (EBV)
Polyclonal B-cell activation
Chronic systemic inflammatory disease marked by alternating exacerbations and remissions
Systemic Lupus Erythematosus (SLE)
SLE peak age of onset is usually between?
20 and 40 years
who is more likely to be stricken by SLE men or women?
Women
in SLE Women are much more likely than men to be stricken, by a margin of
approximately?
10:1
in SLE there is a strong association with human leukocyte antigens (HLA) DR and DQ with?
Whites
in SLE in whites there is a strong association with?
human leukocyte antigens (HLA) DR and DQ
SLE Inherited deficiencies of complement components
C1q, C2, and C4
double the risk of developing lupus
estrogen containing contraceptives or hormone replacement therapy
clinical signs of SLE
- Join involvement (arthritis)
- Erythematous rash
- Butterfly rash
- Diffuse proliferative glomerulonephritis (DPGN)
- Renal failure
The first clue in the mystery of lupus was the discovery of the LE cell by?
Malcolm Hargraves
neutrophil that has engulfed the antibody-coated nucleus of another neutrophil. This phenomenon, which mainly appears in vitro, occurs when cells are damaged and release nuclear material
LE cell
trigger an increase in antibodies directed against DNA and stimulate production of platelet activating factor
Increased production of interleukin-10 (IL-10)
differs from the more chronic form of the disease in that symptoms usually disappear once the drug is discontinued
Drug-induced lupus
- found in the basement membrane
- enhances activation of the complement cascade, which contributes to the kidney damage seen with this disease
α-actin
may also react directly with proteins such as α-actin
anti-DNA antibody
When SLE is suspected, the first test typically done is a screening test for?
antinuclear antibodies (ANA)
extremely sensitive but low specificity
Fluorescent antinuclear antibody (FANA)
Double-stranded DNA (ds-DNA) antibodies are the most specific for SLE, because they are mainly seen only in patients with lupus. (confirmatory if found with low levels of C3)
Antinuclear antibodies
- hemoflagellate, as the substrate
- particularly sensitive assay for ds-DNA is an immunofluorescent test using
Crithidia luciliae
second major antibody found in lupus patients is
antihistone antibody
a nucleoprotein that is a major constituent of chromatin
Histone
Antibodies are also stimulated by DNA complexed to histone, known as
Deoxyribonucleoprotein (DNP)
Presence of antihistone antibody alone or combined with antibody to ss-DNA supports
diagnosis of drug-induced lupus
are also found in rheumatoid arthritis (RA) and primary biliary cirrhosis, but the levels are usually lower
Antihistone antibodies
Extractable nuclear antigens represent a family of small nuclear proteins that are associated with uridine-rich RNA. specific for lupus, because it is not found in other autoimmune diseases
Anti-Sm antibody
protein complexed to a particular type of nuclear RNA called U1-nRNP
Ribonucleoprotein (RNP)
heterogeneous group of antibodies that bind to phospholipid alone or are complexed with protein
Antiphospholipid antibodies
can affect every organ in the body, but they are especially associated
with deep-vein and arterial thrombosis and with morbidity in pregnancy
Antiphospholipid antibodies
cause false-positive results for syphilis
Antiphospholipid antibodies
prolonged activated partial thromboplastin time (aPT) and prothrombin time (PTT)
Lupus anticoagulant
Increased risk of clotting and spontaneous abortion. Platelet functions may also be affected
Lupus anticoagulant
treatment for Fever or arthritis
high dose of aspirin or other anti-inflammatory drug
treatment for skin manifestation
antimalarials such as hydroxychloroquine or chloroquine and topical steroids are often prescribed
in rheumatoid arthritis whos is likely to be affected? men or women?
Women
In RA Women are ? times as likely to be affected as men
three
rheumatoid arthritis occurs at age?
35 and 50
clinical signs for RA
- morning stiffness around the joints lasting at least 1 hour
- swelling of the soft tissue around three or more joints
- swelling of the proximal interphalangeal, metacarpophalangeal, or wrist joints
- Felty’s syndrome
- positive test for rheumatoid factor (RF
- At least four of these must be present for 6 weeks or more for the diagnosis to be made
chronic RA coupled with neutropenia, splenomegaly, and possibly thrombocytopenia
Felty’s syndrome
Organized mass of cells (neutrophils and macrophages)
Pannus
Antibody (IgM class and is directed against the FC portion of IgG)
Rheumatoid factor (RF)
earliest lesions in rheumatoid joints show an increase in cells lining the synovium and an infiltration of mononuclear cells, mostly?
CD4 T lymphocytes
? scattered throughout, as are B cells and antibody producing plasma cells
CD8 T cells
Two types of agglutination tests for RF have been developed?
one using sheep red blood cells coated with IgG and latex particles coated with the same antigen
now the lead marker for detection of RA, because it is much more specific than RF
Anti-CCP
Traditional therapy for RA has included anti-inflammatory drugs such as?
salicylates and ibuprofen to control local swelling and pain
Patients develop a combination of goiter (or enlarged thyroid), hypothyroidism, and thyroid autoantibodies
Hashimoto’s thyroiditis
irregular and rubbery, and immune destruction of the thyroid gland occurs
Goiter
dry skin, decreased sweating, puffy face with edematous eyelids, pallor with a yellow tinge, weight gain, and dry and brittle hair
Hashimoto’s thyroiditis
most common cause of hyperthyroidism
Graves’ disease
a diffusely enlarged goiter that is soft instead of rubbery
thyrotoxicosis
hypertrophy of the eye
Exophthalmus
major antibodies found in Graves’ disease include?
thyroid-stimulating hormone receptor antibody (TSHRab) and antibodies to thyroid peroxidase
elevation of the thyroid hormones and free triiodothyronine (T3) and
thyroxine (T4), decrease TSH
Graves disease
what is elevated and decreased in graves disease
elevated: thyroid hormones and free triiodothyronine (T3) and
thyroxine (T4)
decreased: TSH
The three major autoantibodies present are in autoimmune thyroid diseases
antibodies to thyroglobulin, thyroid peroxidase, and TSH receptors
treatment for Hashimoto’s thyroiditis
thyroid hormone replacement therapy
treatment for Graves disease
radioactive iodine, antithyroid medications such as methimazole, carbimazole, or propylthiouracil with beta blockers as adjuvant therapy
treatment for both hashimoto and graves disease
Surgery to remove part of the thyroid may also be considered as an
alternative
Characterized by insufficient insulin production caused by selective destruction of the beta cells of the pancreas
Type I diabetes mellitus
True susceptibility genes for type I diabetes mellitus may occur in the
HLA-DQ region
True susceptibility genes for type I diabetes mellitus may occur in the HLADQ region, especially in the coding of the?
DQ B chain
treatment for type I diabetes mellitus
insulin, Cyclosporin A, azathioprine, and prednisone
characterized by the formation of lesions called plaques in the white matter of the brain and spinal cord, resulting in the progressive destruction of the myelin sheath of axons
Multiple sclerosis
characterized by the formation of lesions in the white matter of the brain and spinal cord, resulting in the progressive destruction of the myelin sheath of axons
Plaques
autoimmune disease that affects the neuromuscular junction. It is characterized by weakness and fatigability of skeletal muscles
Myasthenia Gravis
Antibody-mediated damage to the acetylcholine receptors in skeletal muscle leads to this progressive muscle weakness
Myasthenia Gravis
characterized by the presence of autoantibody to glomerular, renal tubular, and alveolar basement membranes, resulting primarily in injury to the glomerulus that can rapidly progress to renal failure.
Goodpasture’s Syndrome
dense component of the nucleolus?
Fibrillarin
homogenous staining of the nucleolus in SLE is associated with?
myositis and systemic sclerosis
Antiphospholipid antibodies cause false positive for?
syphillis
lupus anticoagulant causes?
prolonged activated partial thromboplastin time (aPT) and prothrombin time (PTT), increase risk of clotting and spontaneous abortion, platelet function can be affected