Chapter 15: Autoimmunity

Question 1

Autoimmune Diseases

Answer 1

○ Humoral and cell-mediated immune responses directed toward self antigens
○ Cause tissue and organ damage
○ Systemic or organ-specific

Question 2

self-tolerance

Answer 2

Ability of the immune system to accept self-antigens and not initiate an immune response against them

Question 3

Systemic Lupus Erythematosus (SLE)

Answer 3

○ A chronic systemic inflammatory disease that affects multiple organ systems
○ Patients develop numerous autoantibodies
○ Immune complexes form, triggering C’ activation, chemotaxis of neutrophils, and inflammation

Question 4

Clinical Symptoms of SLE

Answer 4

○ Joint involvement
○ Skin rashes (butterfly rash)
○ Renal involvement
○ Neurologic symptoms
○ Anemia, leukopenia, thrombocytopenia

Question 5

Laboratory Tests to Diagnose SLE

Answer 5

○ CBC
○ Urinalysis
○ CRP/ESR
○ Complement quantitation
○ ANAs

Question 6

Antinuclear Antibodies (ANAs)

Answer 6

○ Directed against antigens in cell nuclei
○ Present in more than 95% of lupus patients

Question 7

ENA Ouchterlony Test

Answer 7

Immunodiffusion test detects antibodies to specific ENA

Question 8

Phospholipid Antibodies

Answer 8

○ Found in approximately 60% of lupus patients
○ Can cause false-positive results in nontreponemal tests for syphilis
○ the lupus anticoagulant (produces prolonged APTT and PT)

Question 9

Rheumatoid Arthritis (RA)

Answer 9

Chronic arthritis of the peripheral joints that can progress to joint deformity and disability

Question 10

Some patients with RA can also develop

Answer 10

• Subcutaneous nodules
• Pericarditis
• Interstitial lung disease
• Vasculitis

Question 11

Pathology of RA

Answer 11

○ Inflammation destroys the bone and cartilage
○ TNF-a plays a key role in the process
Overly active osteoclasts absorb the bone

Question 12

Treatment of RA

Answer 12

○ NSAIDs
○ Disease-modifying anti-rheumatic drugs (DMARDs)
○ Biologic agents that target TNF-a

Question 13

Laboratory Testing for RA

Answer 13

○ Rheumatoid factor- Autoantibody (usually IgM) that reacts with Fc portion of IgG
○ Anti-CCP- Autoantibody directed against cyclic citrullinated peptide
○ ANAs
○ ESR, CRP, C’

Question 14

Of the tests for RA which is specific for RA and which isn’t?

Answer 14

Anti-CCP is specific, Rheumatoid factor is not

Question 15

Granulomatosis with Polyangiitis

Answer 15

○ Aka: Wegner’s granulomatosis
○ Rare autoimmune disease involving inflammation of small- to medium-sized blood vessels and respiratory tract

Question 16

Anti-Neutrophil Cytoplasmic Antibodies (ANCA)

Answer 16

○ Produced against proteins in neutrophil granules
○ Strongly associated with syndromes involving vascular inflammation

Question 17

Hashimoto’s Thyroiditis

Answer 17

○ Immune destruction of the thyroid gland produces hypothyroidism
○ Symptoms include fatigue, dry skin, weight gain, brittle hair, formation of a goiter
Characterized by Normal levels of TSH and low Levels of FT4

Question 18

Graves Disease

Answer 18

○ An AITDS characterized by hyperthyroidism
○ Symptoms: nervousness, weight loss, rapid heart beat, goiter, exophthalmos
○ Low TSH and high FT4

Question 19

Type I Diabetes Mellitus (T1D)

Answer 19

○ Endocrine disorder characterized by hyperglycemia
Type 1 destruction of b cells in pancreas results in insulin deficiency

Question 20

Celiac Disease

Answer 20

○ Affects small intestine and other organs
○ Triggered by gluten

Question 21

Autoimmune Liver Diseases

Answer 21

Immune-mediated liver diseases that can lead to end stage liver failure if untreated

Question 22

Autoimmune hepatitis (AIH)

Answer 22

○ Hepatocytes targeted
○ AIH-1- Positive for SMA, ANAs
○ AIH-2- Positive for LKM-1 or LC-1 antibodies

Question 23

Primary biliary cirrhosis (PBC)

Answer 23

○ Destruction of intrahepatic bile ducts; cholestasis
○ Majority of patients produce mitochondrial Abs (AMAs)

Question 24

Multiple Sclerosis (MS)

Answer 24

involves inflammation and destruction of the central nervous system

Question 25

Myasthenia Gravis

Answer 25

Affects neuromuscular junction, resulting in weak skeletal muscles

Question 26

Goodpasture’s Syndrome

Answer 26

Patients produce autoantibodies to basement membranes lining the renal glomeruli and lung alveoli