Autoimmune Pathology Flashcards
The immune response is characterized by a balance of
-chemical messengers that are made by inflammatory cells and promote other cells to incr/decr immune response
Type I Hypersensitivity
-IgE is produced instead of IgG
Type I Hypersensitivity Reactions
- hay fever
- allergic rhinitis
- extrinsic asthma
- anaphylactic shock
-Local and potential systemic response with exposure to allergen
Type II Hypersensitivity
-cytotoxic reaction to self-antigens
Type II Hypersensitivity Reactions
- blood transfusion reactions
- hemolytic disease of newborn
- autoimmune hemolytic anemia
- myasthenia gravis
Type II Hypersensitivity can also occur with a cross reaction between ____ & _____
- exogenous pathogens
- endogenous body tissues
Type III Hypersensitivity
- immune complex disease
- antigen-antibody complexes deposit in tissues around small blood vessels–>vasculitis
Vasculitis Affects the:
- skin
- joints
- kidneys
- pleura
- pericardium
Type IV Hypersensitivity
-delayed hypersensitivity such as contact dermatitis with exposure to allergens such as poison ivy, adhesive, latex
Type IV Hypersensitivity Reactions
- graft vs host disease
- transplant rejection
Antigens processed by ____ and presented to ____
- macrophages
- T cells
___ & ____ cells respond and recruit lymphocytes, monocytes and macrophages
- T4
- T8
Cause of Autoimmune Disorders
Auto-Antigens
- drugs produce several autoimmune responses
- photosensitivity can cause allergic reactions in some pts
- trauma, infections, emotional distress can be triggers for some autoimmune diseases
Cause of Autoimmune Disorders
Antigenic Stimulation/Suppressor T Cell Suppression
- antigenic stimulation results in antibody formation, activating T cells
- autoimmune reaction is normally held in check by suppressor T-cells.
- Suppressor T-Cell Suppression
Cause of Autoimmune Disorders
Genetics
- women>men
- higher incidence of same type of auto-antibodies or similar autoimmune diseases in relatives
Autoimmune disorders
–condition where immune system produces auto-antibodies to an endogenous antigen with injury to tissues
Auto-Antibodies Contribute to:
- Diabetes: T-cells attacking pancreas
- RA: auto-antibody called rheumatoid factor
Examples of Autoimmune Disorders
- SLE
- Psoriasis
- Psoriatic Arthritis
- Grave’s Disease
Grave’s Disease
-antibodies against thyroid cell membrane, including TSH receptors
Immune reactions are characterized by:
- inflammation which may be chronic
- results in damage to normal tissues
Areas affected by autoimmune disorders
- connective tissue in/around joints inflammed
- inflammed muscles
- pericardium
- pleura
- brain
Lab Tests of Autoimmune Diseases Reveal
- thrombocytopenia
- leukopenia
- immunoglobulin excesses or deficiencies
- antinuclear antibodies
- rheumatoid factor
- cryoglobulins
- false-positive
- serologic tests
- elevated muscle enzymes
- alterations in seru complement
Clinical Manifestations of Autoimmune Disorders
- synovitis
- pleuritis
- myocarditis
- endocarditis
- pericarditis
- peritonitis
- vasculitis
- myositis
- skin rash
- nephritis
- alterations in connective tissue
- constitutional symptoms
Constitutional Symptoms
- fatigue
- malaise
- myalgias
- arthralgias
Management of Autoimmune Disorders
- suppression of immune system
- palliative management of symptoms
- immunoablation then stem cell transplantation
- possibility of vaccines
- gene therapy
Examples of Autoimmune Disorders
- addison’s disease
- crohn’s disease
- chronic active hepatitis
- DM
- primary biliary cirrhosis
- grave’s disease
- Hashimoto’s disease
- Ulcerative Colitis
- Giant cell arteritis
- hemolytic anemia
- idiopathic thrombocytopenia
- polymyositis
- dermatomyositis
- post-viral encephalitis
- amyloidosis
- ankylosing spondylitis
- mixed connective tissue disease
- fibromyalgia
- MS
- polymyalgia rheumatica
- progressive systemic sclerosis
- psoriasis
- Reiter’s syndrome
- RA
- Sarcoidosis
- Sjogren’s Syndrome
- SLE
Rheumatism
- any disorder marked by inflam, degen or metabolic derangement of connective tissue, especially joints
- pain, stiffness, limited movement
Gout
- recurrent acute/chronic arthritis of peripheral joints that results from hyperuricemic body fluids
- leads to formation of deposits in joints, soft tissue and kidneys
Diagnosis of Gout
- synovial fluid assessment
- elevated serum uric acid
Management of Gout
- may improve with weight loss & decreased consumption of alcohol & purines
- NSAIDs
- rest/protect joints
Psoriatic Arthritis
- RA-like arthritis associated with psoriasis of skin/nails
- in people with psoriasis
- painful, inflamed joints
Juvenile RA
- chronic inflammatory, systemic disease
- damage to connective tissue and viscera
RA
- chronic, systemic disorder
- affects synovial membrane and articular cartilage of entire body
RA Imaging
- X-ray
- marginal bony erosion
RA usually affects joint
-symmetrically
RA commonly affects
- wrists
- hands
- elbows
- shoulders
- knees
- ankles
Smoking increases risk of:
-RA
Anklylosing Spondylitis
-inflam of axial skeleton & large peripheral joints
Initial Symptom of Anklylosing Spondylitis
- insidious onset of LBP, buttock or hip pain
- decreased chest excursion & spinal mobility
- decreased Lumbar lordosis
After initial inflammation of Anklylosing Spondylitis
- SI joints fuse
- leaves no trace of joint surfaces
- then spine fuses (bamboo spine)
Treatment of Anklylosing Spondylitis
- NSAIDs for pain
- bisphosphonate drugs for severe back pain
- stretching
- aerobic ex’s
- breathing exercises
- trunk extensor strength
- pain free rotation
Scleroderma
systemic sclerosis
- chronic disease
- diffuse fibrosis
- degenerative changes
- vascular abnormalities of skin, articular surfaces, internal organs (GI, lung, heart, kidney)
Early Manifestation of Scleroderma
-bilateral symmetric swelling of fingers and hands
In Scleroderma, edema is replaced by ______ in a few weeks to several months resulting in ________
- induration
- thick, hard skin
In Scleroderma skin thickness spreads rapidly within _____ to _____
- months
- forearms, upper arms, face, trunk
Scleroderma Fingertips
- taut
- shiny
- thickened
- contractures of hands
Scleroderma Profile
- female> male (5:1)
- age 30-50
- could be after severe emotional shock
Pathogenesis of Scleroderma
- widespread vasculopathy
- fibrosis
- relentlis deposition of collagen in blood vessels
- connection between vasculopathy and skin fibrosis not understood
3 Stages of Scleroderma
- edematous stage
- sclerotic stage
- atrophic stage
- skin calcification (stage 4)
Edematous Stage
-bilateral non-pitting edema in fingers/hands
Sclerotic Stage
- skin taut, waxy and smooth
- appears bound to underlying tissue
Atrophic Stage
- skin atrophies
- contractures
- ulcerations at joints
Classification of Scleroderma
- Systemic
- Localized
- overlap (associated with PD/DM)
- diffuse (rapid progressing)
Systemic Scleroderma
-skin thickening in distal extremities and face
Localized Scleroderma
- single/multiple plaques without fibrosis
- single/multiple bands involving skin and deeper tissue
Clinical Manifestations of Scleroderma
- Cardiovascular: HTN
- Joints: arthritis
- Lungs: interstitial fibrosis
- GI: esophageal dysfunction
- Kidney: leads to HTN; renal failure, death
- CREST Syndrome
CREST Syndrome
- Calcinosis
- Raynaud’s phenomenon
- Esophageal dysmobility
- Sclerodactyly
- Telangiectasia
Raynaud’s Phenomenon
- Abn vasoconstriction followed by vasodilation
- pale, cool and painful–>red
- agg by cold, vibratory forces, tobacco use
Scleroderma Management
- NSAIDs for pain
- Penicillamine: slow thickening
- Immunosuppressants
PT Management of Scleroderma
- prevent skin damage
- prevent infections
- wound care
- avoid excessive bathing/moisturizing creams with glycerin
- strenghtening
- ROM
- soft tissue mob (careful)
- aquatic theray
- joint protection/splints
Exercise for Scleroderma
- aerobic
- endurance
- monitor BP
Scleroderma Prognosis
- variable
- can be fatal
- worse for Sx with heart, lung, kidney damage
SLE
- systemic lupus erythematosus
- chronic inflam connective tissue disorder of unknown origin that involves joints, kidneys, serous surfaces, vessel walls
SLE Profile
- young women
- 15-40 years old
- children
- black, asian, native americans
Cause/risk factors of SLE
-familial link
-genetic susceptibility
-triggered by endog/exogenous factors
(stress, infection, exposure to sunlight, certain drugs)
Pathogenesis of SLE
- disease of generalized immunity
- body produces antibodies against tissues
- nonspecific inflammation
Clinical Manifestations of SLE
- variable
- Malar (butterfly) rash
- discoid lesions
- arthritis, arthralgia
- headaches
- irritability
- depression
- emotional instability
- psychosis
- seizures
- CVA
- cranial neuropathy
- peripheral neuropathy
- organic brain syndrome
- tachycardia
- pneumonitis
- HTN
- thrombosis risk
- myocarditis
- kidney failure
- altered leels of RBC, WBC, throbocytes
- fever
- weight gain
- fatigue
Discoid Lesions
- SLE
- raised red, scaling plaques
- neck, face, chest
Management of SLE
- NSAIDs for pain
- no corticosteroids
- anticoagulants
- immunosuppressants
- immunizations to decr infection risk
- organ specific meds
PT with SLE
- ex’s to prevent Mm weakness/fatigue
- avoid sunlight
- stress management
- avoid alcohol
- monitor signs of infection/necrosis
- monitor renal involvement
Fibromyalgia
- chronic muscle pain syndrome
- lowered threshold for noxious stimuli
FMS
-fibromyalgia syndrome
Fibromyalgia can be associated with
- hypothyroidism
- RA
- SLE
- chronic fatigue syndrome
Fibromyalgia Profile
- women>men
- age 14-85
- less in trained athletes
Risk Factors for Fibromyalgia
- prolonged anxiety
- stress
- trauma
- rapid steroids withdrawal
- hypothyroidism
- extracapsular silicone (breast implants)
- non-viral infections
Cause of Fibromyalgia
- diet
- infection
- sleep disorder
- occupational
- seasonal/environmental influences
- adverse childhood experiences
- sexual abuse
- psychological distress
Fibromyalgia Pathogenesis
DISTURBANCES IN:
- hypothalamic-pituitary-adrenal axis
- ANS
- reproductive hormone axis
- immune system
Fibromyalgia and Exercise
-blood doesn’t flow to exercising muscles
Diagnostic Criteria
- widespread pain index & symptom severity scale
- at least 3 months
- rule out other causes
- 18 specific points on body
Clinical Manifestations of Fibromyalgia
- multiple tender points & muscle pain
- disturbed sleep
- morning fatigue/stiffness
- swelling/numbness
- chronic headaches
- IBS
- Raynaud’s
- Dysmenorrhea-painful
- exercise intol
- weakness
Management of Fibromyalgia
- Thyroid hormone
- stress management
- pain management
- drug therapy (multimodal)
- modalities for pain
- cognitive therapy
- aerobic ex’s
- aquatic therapy
- gentle exercise
- monitor for post-exertional muscle pain
- monitor overuse syndromes
