Autoimmunity Flashcards
Define autoimmunity. (2)
An immune response against the host due to the loss of immunological tolerance to self-antigens.
Define autoimmune disease. (2)
A disease caused by the tissue damage or disturbed physiological responses due to an autoimmune response.
Describe the two types of autoimmune reaction. (4)
Organ specific - autoantibodies against a one-organ antigen. Can still have systemic effects.
Non-organ specific - widely distributed antigens
Describe the consequences of an autoimmune reaction. (3)
A hypersensitivity reaction is prompted, leading to tissue fibrosis that impairs function and will be unresponsive to treatment.
Name three autoimmune diseases that can be passed onto foetuses and present in the newborn. Explain why these can. (5)
Graves’ disease, SLE and DMII. These have autoantibodies that are IgG, so can be passed on to the baby through the placental circulation.
Name the self antigen, the result, the organ specificity and the type of hypersensitivity for: Hashimoto’s thyroiditis. (5)
Antigen: thyroid peroxidase and thyroglobulin
Result: hypothyroidism
Organ specific
Type of hypersensitivity: IV
Name the self antigen, the result, the organ specificity and the type of hypersensitivity for: DMI (4)
Antigen: pancreatic islet cells
Result: hyperglycaemia
Organ specific
Type of hypersensitivity: IV
Name the self antigen, the result, the organ specificity and the type of hypersensitivity for: Multiple Sclerosis (4)
Antigen: myelin sheath
Result: demyelination
Organ specific
Type of hypersensitivity: IV
Name the self antigen, the result, the organ specificity and the type of hypersensitivity for: Goodpasture’s Disease (5)
Antigen: glomerular / alveolar basement membrane
Result: glomerulonephritis
Organ specific
Type of hypersensitivity: II
Name the self antigen, the result, the organ specificity and the type of hypersensitivity for: Addison’s Disease (5)
Antigen: steroid-21 hydroxylase in adrenal cortex
Result: adrenal insufficiency
Organ specific
Type of hypersensitivity: unknown (II / IV)
Name the self antigen, the result, the organ specificity and the type of hypersensitivity for: Graves’ Disease (4)
Antigen: thyroid stimulating hormone receptor
Result: hyperthyroidism
Organ specific
Type of hypersensitivity: II
Name the self antigen, the result, the organ specificityand the type of hypersensitivity for: Myasthenia Gravis (4)
Antigen: acetylcholine receptors in neuromuscular junction
Result: skeletal muscle weakness
Organ specific
Type of hypersensitivity: II
Name the self antigen, the result, the organ specificity and the type of hypersensitivity for: Pernicious anaemia (4)
Antigen: intrinsic factor in the terminal ileum
Result: B12 deficiency
Organ specific
Type of hypersensitivity: II
Name the self antigen, the result, the organ specificity and the type of hypersensitivity for: Autoimmune haemolytic anaemia (4)
Antigen: red blood cell antigens
Result: anaemia
Not organ specific
Type of hypersensitivity: II
Name the self antigen, the result, the organ specificity and the type of hypersensitivity for: Rheumatoid arthritis (4)
Antigen: rheumatoid factor on IgG
Result: inflammatory arthritis
Not organ specific
Type of hypersensitivity: IV
Name the self antigen, the result, the organ specificity and the type of hypersensitivity for: SLE (5)
Antigen: dsDNA and histone proteins
Result: multisystem disease
Not organ specific
Type of hypersensitivity: III
Name the self antigen, the result, the organ specificity and the type of hypersensitivity for: Sjogens’ Syndrome (5)
Antigen: nuclear antigens
Result: dry eyes and mouth, arthritis
Not organ specific
Type of hypersensitivity: IV
Describe the six criteria for diagnosing autoimmunity. (6)
1 - presence of autoantibodies or autoreactive T cells.
2 - levels of autoantibodies correlate to disease severity.
3 - autoantibodies / autoreactive T cells are found at the site of tissue damage.
4 - transfer of autoantibodies or autoreactive T cell into a healthy host will induce the disease in the host.
5 - clinical benefit provided by immunomodulatory therapy.
6 - Family history
Name four factors that increase the risk of developing autoimmune disease. (4)
Hormonal
Infectious
Drugs
Genetics.
Describe the effects of hormones on the chances of developing an autoimmune disease. (3)
All autoimmune diseases are more common in women (esp SLE, Hashimoto’s, Graves). Suggests a link with oestrogen or prolactin.
Describe the links between certain autoimmune diseases and infections. (6)
Strep pyogenes M protein and Rheumatoid arthritis
Campylobacter jejuni glycoproteins and Guillian-Barré
Coxsakieviruse nuclear protein and DMI.
Describe the links between certain autoimmune diseases and drugs. (10)
D penicilamine (used for RA) and SLE, glomerulonephritis, and myasthenia Gravis. Methyl-dopa (antihypertensive) and haemolytic anaemia Hydralazine (antihypertensive), procainamide (anti-arrythmic) and isoniazid (anti-TB) associated with SLE.
Describe the types of autoantibody. Give two examples of each. (8)
Primary - autoantibody is responsible directly for the tissue damage - Graves’, myasthenia Gravis.
Secondary - autoantibody is associated with the disease but finding it is not diagnostic alone - SLE, RA.
Describe the treatments of: Hashimoto’s thyroiditis
Replacement therapy - levothyroxine
Describe the treatments of: DMI
Replacement therapy - insulin
Describe the treatments of: Multiple Sclerosis
Anti-inflammatory drugs / MABs
Describe the treatments of: Goodpasture’s Disease
Plasmapheresis
Dialysis
Describe the treatments of: Addison’s Disease
Replacement therapy - aldosterone
Describe the treatments of: Graves’ Disease
Anti-thyroid drugs (carbemazole)
Plasmapheresis
Surgery
Describe the treatments of: Myasthenia Gravis
Acetylcholineesterase inhibitors
Immunosuppressants eg pyridostigmine
Describe the treatments of: Pernicious anaemia
Replacement therapy - B12 injections
Describe the treatments of: Autoimmune haemolytic anaemia
Anti-inflammatory drugs
Splenectomy
Describe the treatments of: RA
Immunosuppression / MABs
Describe the treatments of: SLE
Immunosuppression / MABs.
Describe the occurrence of SLE. (3)
More common in women (ratio of 9:1)
Afro-Caribbean > south Asian > Caucasian
Describe the symptoms characteristic of Lupus. (13)
A RASH POINts Medical Diagnosis ANA positive Renal abnormalities Arthralgia / arthritis Serositis Haematological abnormalities Photosensitivity Oral ulcers Immunological abnormalities Neurological abnormalities Malar rash Discoid rash 4 / 11 = SLE
Describe the treatments available for SLE. (8)
Patient education - lifestyle modification, sunscreen use.
Start DMARDs - hydroxychloroquine, azathioprine.
Use steroids - prednisolone
In severe cases - IV cyclosphamide
Describe the predisposing factors to getting Rheumatoid arthritis. (4)
Female : male = 3 : 1
No racial predilection
Genetic factors
Environmental factors - smoking, bad oral hygiene
Describe the important things to focus on in a history about either SLE or RA. (10)
Pain, stiffness, swelling, patten of joints involved (often small joints of fingers).
Acute or chronic? Family history? Response to treatments?
Any secondary symptoms - skin, eyes, lungs, malaise, sweats, weight loss, poor appetite, fever.
Describe the correct approach to examination of a patient with Lupus. (13)
The “Glove and Sweater” approach
Hands:
- Raynauds, joint pain/swelling, rash.
Torso:
- proximal muscle weakness, limb weakness
- hair loss, eye/mouth dryness, nose bleeds, ulcers, photosensitivity
- pleuritic chest pain, pericardial rub
Describe the investigations you would do if suspecting Lupus. (4)
Routine bloods - FBC, U+E, LFT, CRP, creatinine.
Lupus bloods - antibodies against nucleus, dsDNA, phospholipids.
Give one secondary symptom that is found in RA but not in SLE. (2)
Caplan’s Syndrome - lung nodules and RA.
Describe the investigations you would do if RA was suspected. (5)
Routine bloods - FBC, U+E, LFT, CRP, creatinine.
RA bloods - Rheumatoid factor autoantibody, antineuclear.
X rays and USS of joints and chest.
Describe the treatments available for RA. (4)
Combinations common.
DMARDs early - methotrexate, hydroxychloroquine.
Use of steroids: prednisolone