Clinical Approach to Autoimmunity Flashcards
What is autoimmune disease?
Breakdown of self-tolerance
Prod of pathogenic Abs
Multi-systemic features
Outline the importance of auto-Abs
Aid diagnosis
Associated with specific clinical features
Disease prognosis
To individualise therapy
What is systemic lupus erythematous?
T3 hypersensitivity
apoptosis = remnant, self Ag, DNA, histones = normally phagocytosed, when NOT = self Ag via lymph to APC = presented to T cell = stim B cell = auto-Ab
NO inactivation of T/B cells = breakdown of self tolerance
Anti-nuclear Abs = bind proteins within the nucleus
Other auto-Ab = anti-SM
Abnormal cytokine prod, activation of complement, influx of neutrophils
Afro-caribbean > S asians > caucasians
What symptoms show in SLE?
CVS = pericarditis, myocarditis, endocarditis Renal = glomerulonephritis Repro = spontaneous abortion, neonatal lupus Haematology = anaemia
SKIN =
- red rash on the face = butterfly rash
- photosensitivity
- urticarial
- vasculitis
- purpura
How is SLE treated?
Pt education
Sunscreen
DMARDs = disease modifying drugs
Steroids
Immunosuppressants
What might you see on a FBC of a pt with SLE?
anaemia
low WBC count
low platelet count
What is rheumatoid arthritis?
Rheumatoid factor = Auto-Ab to Fc portion of IgG
Anti-cyclic citrullinated peptide = Anti-CCP
Anti-citrullinated protein Ab = Anti-ACPA
interaction between macrophages and T/B cells = over prod TNF = persistent synovitis/joint destruction = chronic symmetrical polyarthritis with systemic inflam
What are the symptoms of RA?
Pain
Stiffness
Swelling
Symmetrical pattern of joint involvement
What investigations are performed for RA?
FBC, U+E, LFT, CRP, ESR
X-ray, ultrasound (sensitive to swelling)
Anti-nuclear Abs, rheumatoid factor Abs
How is RA treated?
Disease modifying drugs = methotrexate
Steroids = prednisone
MAb = infliximab, rituximab
What complications can arise from RA?
Methotrexate (Immunosuppressive) = recurrent infection, lung fibrosis, long-term inflam
RA nodules
Carpal tunnel syndrome
CVS = prone to atherosclerosis, MI, stroke
Resp = nodules, pleural effusion, interstitial lung disease
What is Graves disease?
T2 Hypersensitivity
Thyroid stimulating Ig (TSI) = stim TSH receptor
Clinical feature =
- exopthalmus
- pre-tibial myxoedema
- goitre
- weight loss
maternal = neonatal hyperthyroidism, death
What is the treatment for Graves disease?
carbimazole
radioactive iodine = destroy thyroid cells
sub-total/thyroidectomy
What is Hashimoto’s disease?
Anti-thyroglobulin Ab
Anti-thyroid perioxidase Ab
Clinical features =
- weight gain
- bradycardia
- peaches + cream face
- loss of outer third eyebrows
Thyroid biopsy = lymphocytes, plasma cells
Outline the management for hashimotos disease
replacement thyroxine
monitor clinically = TSH should return to normal
