Autommune disorders Flashcards
Autoimmune process
If the auto tolerance breaks down in the organism, and immune reaction starts to appear against autoantigens
Autoimmune disorder
if autoimmune processes reach a degree when a clinical signs appear
Autotolerance/Burnet´s clone-selection theory
Autoantigens in early life encounter with immatrure lymphocytes; and these lymphocytes die or become tolerant.
Later, during life som autoantigens may change (for example because of virus or drug); and auto reactive clones can arise against these changed auto-antigens
In normal ways, these auto reactive clones are suppressed by T-cyxotoxic cells.
Autotolerance
The ability of the body not to stimulate immunocompetent cells into an immune response to potential antigens that are components of one’s own tissues and cells.
The break down of autotolerance
- The disturbance of autotolerance;
- antigen-dependent causes: changed own antigens (virus, drug)
- Immunregulation
Etiological factors
Next to the breakdown of autotolerance, a number of etiological factors can play a role:
- genetic predisposition
- something that induces inflammation
- hormonal milieu (mainly sexual hormones)
- environmental factors
- psychological factors (stress)
Grouping of autoimmune disorder
Polysystemic autoimmune disorders
Organ-specific autoimmune disorders
To simple classification??
- they overlap (do you have one auto.dis., higher probability to have another)
- auto.dis. can be placed to a spectrum
Polysystemic autoimmune disorders
Immune reaction against general cell-component in different kind of cells
Impairment do not limited to one single organ, or one type of cells
EX: systemic lupus erythematosus (SLE)
Organ-specific autoimmune disorders
Immune reaction against a specific auto-antigen
Systemic Lupus Eruthematosus (SLE) + epidemiology
- more frequent in afro-american woman than white
- more frequent in Europe than in US
SLE + etiology
Multicausal origin:
- genetic predisposition
- virus infection
- hormones (sign. female dominance)
- pharmacological substances
- external factors
- psychological stress
Pathogenesis + SLE
It is a prototype autoimmune disorder and can affect more organs.
- disturbed function of T-cells
Clinical symptoms + SLE
General symptoms:
- fever
- fatigue
- weight loss
- swelling of lymph nodes
Other symptoms:
- skin symptoms
- hair loss
Therapy + SLE
Only symptomatic treatment
in mild cases: rest, avoiding sunshine and stress
wild cases: corticosteroids, plasmapheresis
Prognosis + SLE
5 year survival rate: 95%
10 year survival rate: 70%
People diagnosed in younger age have better prognosis
Pain + SLE
Significant problem for Lupus patient: most frequent pain of SLE; headache and chest pain
Cognitive disturbance + SLE
Cognitive disorders are very frequent in SLE. the most frequent:
- attention deficit, concentration problems, psychomotor speed, cognitive flexibility, verbal and non-verbal memory
Fatigue + SLE
The most frequent symptom of lupus patient with important physical, emotional and social limitations
Sleep problems + SLE
Very frequent in SLE, and one of the most determinative factors of QoL.
- longer time to get to sleep
- longer night sleep
- sleep disorder have significant effects on depression and on fatigue
Valencia-Flores (1999)
(SLE)
- worse quality of slepp
- frequent awake
- more restlessness and disturbed sleep
- more sleepiness and fatigue
Bouyer (1998)
The response of sleep-wake cycle to acute stress depends on the individual stress-reactivity defined by HPA axis.
Sexual hormones + SLE
Sexual hormones can have important role in the disease;
- 60% report that their health status depends on the menstrual cycle
- disturbance of the metabolism of estrogen (higher level) and testosteron (lower level) in both sexes
Disturbance in sexual behavior + SLE
in chronic diseases significant changes in sexual behavior
C-type personality + SLE
- extreme conformity
- extreme kindness
- feeling unvaluable
- self-victimization
- inability to express different opinion
- self-restrained
- strong emotion-control
Coping + SLE
the lack of appropriate coping mechanisms are more frequent in lupus patient than in healthy population.
Celiac disease
Autoimmune disorder with an inappropriate immune response to the dietary protein gluten.
After absorption in the small intestine these proteins interact with the antigen-presenting cells causing an inflammatoryy reaction
Risk factors for celiac disease
- First degree relative with the disease
- Down syndrome
- T1DM
Is Down syndrome a risk factor for celiac disease?
YES!
Is celiac disease an allergy?
NO!
Classic clinical presentation of celiac disease?
Diarrhea
gas/bloating
Weight loss
Atypical clinical presentation of celiac disease?
- constipation
- anemia
- osteiprosis
- rash
- ataxia
- infertility
Silent clinical presentation of celiac disease?
No signs
abnormal biopsy
LAtent clinical presentation of celiac disease?
No signs
normal biopsy
Nearly 30% of the population has a genetic vulnerability for gluten sensitivity?
TRUE
Increased gut permeability is a risk factor for celiac disease?
TRUE
Diagnosis of celiac disease?
Small bowel biopsy
Blood test: immunoglobulin A,
Psychological/psychiatric comorbidities
- major depression
- panic disorder
- dysthymia, anxiety
Autistic symptoms can improve on gluten diet?
TRUE
Neurological problems + celiac disease?
- ataxia
- neuropathy
- epilepsia
- stroke
- headaches
- learning and attention disorders
Headache is very frequent in celiac disease?
TRUE
QoL + Celiac disease
- worse than in normal population
- somatic symptoms
- social withdrawal because of diet
The average delay of getting a diagnosis is around 3 years (celiac disease?
FALSE
Problem with diet (celiac disease)
- only 60% follow the appropriate diet (low availability of gluten-free product, expensive, difficult to find gluten-free restaurants)
- predictors of poor adherence
lack of education, poor self regulation, lack of gastrointestinal symptoms
lack of imporvement
Diarrhea is a “compulsory” symptom of the disease?
FALSE
