Autoimmune Disorders (Test 2) Flashcards
Occurs when immune system reacts against self-antigens and a person’s own tissues are damaged by antibodies or autoreactive T cells.
autoimmunity
What is the most common chronic inflammatory arthritis?
rheumatoid
Does RA have a higher incidence in men or women?
2-3 x higher in women
What are the causes of pericardial effusion?
can occur from almost any pericardial disease such as infection, trauma, metastatic disease, mediastinal disease, radiation, rheumatoid arthritis, systemic lupus erythematosus, and scleroderma
What is the underlying pathology in the joints of patients with RA?
cellular hyperplasia occurs in the synovium with progressive infiltration by lymphocytes, plasma cells, and fibroblasts–> the articular cartilage is eventually completely destroyed
What symptoms characterize RA?
symmetric polyarthropathy (involves 5 or more joints simultaneously; is usually caused by autoimmune) ->affects weight bearing joints, proximal interphalangeal and metacarpophalangeal joints; worse in a.m.; in severe case all joints may be affected except lumbar and thoracic spine; weight loss, morning stiffness, and fatigue; insidious onset
What are treatment options for RA?
palliative; corticosteroids suppress inflammatory symptoms of RA; anticytokine agents (etanercept, adlimumab, and infliximab) interfere with cytokine known as tumor necrosis factor–> slowing progression of disease; methotrexate (1st line therapy–>inhibits metabolism of folic acid–> nausea, alopecia, h/a, skin pigmentation is common) is effective in reducing symptoms, as are immunosuppressive drugs such as cyclophosphamide & cyclosporine
methotrexate use: For the treatment of rheumatoid arthritis, inhibition of DHFR is not thought to be the main mechanism, but rather the inhibition of enzymes involved in purine metabolism, leading to accumulation of adenosine, or the inhibition of T cell activation and suppression of intercellular adhesion molecule expression by T cells.[21] In these cases, patients should supplement their diets with folate.
What are some major anesthetic considerations for patients with RA?
careful airway evaluation d\t arthritic changes in laryngeal, temporomandibular, and cervical joints; chronic NSAID use may inhibit platelet function & lead to liver or kidney dysfunction; use of cyclophosphamide (immunosuppressive) can inhibit plasma cholinesterase and prolong DOA of Sux; use of long-term corticosteroid therapy will warrant extra steroid coverage
What is the most common hematologic abnormality in RA?
anemia
What is the most common pulmonary complication of RA?
pleural effusion (excess of fluid between pleural layers–> impairing breathing and limiting expansion)
What are some cardiac complications that may be present with RA?
1/3 patients exhibit pericardial thickening with effusion; pericarditis, myocarditis, and coronary artery arteritis may be present; aortitis may produce dilation of aortic root and subsequent aortic regurgitation…. rheumatoid nodules may also disrupt cardiac conduction system
What are the airway management concerns with RA?
may affect TMJ and restrict mouth opening; may affect joints of the larynx and cause generalized edema and laryngeal swelling; cervical spine instability and atlantoaxial subluxation can push odontoid process into foramen magnum during laryngoscopy
What is the difference b\w osteoarthritis and RA?
RA is characterized by immune-mediated joint destruction with chronic and progressive inflammation of synovial membranes; as opposed to being caused by articular wear and tear of osteoarthritis, which is a degenerative disease affecting the articular surface of one or more joints
________ is a systemic disease affecting one or more organ systems.
RA
Why does RA typically cause deformity in patients?
b\c it often affects small joints of hands, wrists, & feet causing severe deformity–> leads to difficulty placing radial artery cannula or intravenous access
If a patient with history of RA is taking steroids, immune therapy, or methotrexate…. what is an important diagnostic test to consider prior to surgery?
flexion and extension radiographs of cervical spine; if atlantoaxial (C1-C2) instability is present intubation should be done with inline stabilization and fiberoptics
What is the importance of assessing mouth opening in a patient with RA?
if TMJ involvement is found, patient may have limited jaw mobility and ROM
What are some concerns with the use of NSAIDs by patients with RA?
GI bleeding, renal toxicity, platelet dysfunction
What is an endocrine concern for patients with RA?
adrenal insufficiency and impaired immune system (from glucocorticoid therapy)
According to slides from class, what are some of the etiologic causes of RA?
exact cause unkown; impaired immunity, stress, & environmental factors may have role; viral or bacterial infection altering the immune system in genetically susceptible host may play a role (autoimmune response, molecular mimicry); circulating autoantibodies called rheumatoid factors are detectable in 70-80% of patients with RA
What are the most common sites for RA manifestations in the joints?
hands, wrist, feet
Joint involvement in RA progresses in 3 main stages. Explain.
1) inflammation of joint synovial membrane and infiltration by leukocytes; 2) rapid division and growth of cells in joints; 3) liberation of osteolytic enzymes, proteases (any enzyme responsible for proteolysis), and collagenases–> damage small blood vessels, cartilage, ligaments, tendons, bones; THESE PROCESS LIMIT THE JOINTS ROM
What are the early and late characteristics of RA?
early: morning stiffness, weight loss, and fatigue; late: severe pain, joint instability, and crippling deformities
What is the concern with arthritis of the cricoarytenoid joint of the larynx?
40% of RA patients; obstructs airflow; red, swollen on DL; difficult intubation; symptoms= larynx tenderness, hoarseness, painful swallowing radiating to ear, dyspnea or stridor
What is Sjogren’s Syndrome?
a systemic autoimmune disease in which immune cells attack and destroy exocrine glands that produce tears and saliva; immunologically mediated lacrimal and salivary gland destruction
Does Sjogren’s primarily affect men or women?
9/10 are women; and is often associated with other autoimmune disorders (SLE and RA)
What are the symptoms of Sjogren’s Syndrome?
Sicca symptoms such as xerophthalmia (dry eyes; “xero” tears), xerostomia (dry mouth), and parotid gland enlargement (major human salivary gland)
What is scleroderma?
sclerosis of the skin; disease associated with immune dysregulation and several autoantibodies; injury to vascular endothelial cells–> leakage of serum proteins–> tissue edema–> lymphatic obstruction–> fibrosis; poor prognosis
What is the treatment for scleroderma?
NO drugs or treatments are effective
What are the characteristics of scleroderma?
inflammation, vascular sclerosis, and fibrosis of skin and viscera; from stoelting: characterized by inflammation, vascular sclerosis, and fibrosis of the skin and viscera (may evolve into CREST)
What is the etiology of scleroderma?
unknown; but characteristics of both a collagen vascular disease and autoimmune; age 20-40; women>men; pregnancy accelerates disease in 50% of patients; prognosis is poor and r\t extent of visceral involvement
What are anesthetic considerations with scleroderma?
plan for difficult airway; oral or nasal telangiectasias (may bleed profusely); thick skin so difficult line insertion; contracted intravascular volume–> hypotension; pulmonary aspiration; decreased pulmonary compliance requires increased pressures; supplemental O2; prevent increased PVR; sensitive to respiratory depressant effects of opioids
_______ is an autoimmune disorder characterized by weakness and easy fatigability of skeletal muscle.
Myasthenia Gravis
What causes the weakness associated with myasthenia gravis?
autoimmune destruction of post-synaptic AcH receptors at the NMJ—> reduced numbers of receptors and degradation of their function, and to complement-mediated damage to post-synaptic end plate
The complement system helps or “complements” the ability of antibodies and phagocytic cells to clear pathogens from an organism. It is part of the immune system called the innate immune system[1] that is not adaptable and does not change over the course of an individual’s lifetime. However, it can be recruited and brought into action by the adaptive immune system.
