Dobson lecture- autoimmunity and corticosteroids

Question 1

if you have one autoimmune disease are you likely to have another?

Answer 1

yes

Question 2

what is the function of the thymus in relation to autoimmune disease?

Answer 2

the thymus works to remove T cells that have a strong affinity for self antigens

Question 3

what happens if there is a genetic failure of the thymus?

Answer 3

T cells with strong affinity for self antigens are not removed

Question 4

how does the environment trigger autoimmune diseases?

Answer 4

likely that pathogen mimics self antigen and send danger signal that causes dendritic cells to activate t helper cells leading to an immune response and tissue damage

Question 5

how do you diagnose autoimmune diseases?

Answer 5

-blood tests- inflammatory markers and autoantibodies
-clinical presentation
-radiographs

Question 6

what antibodies are found in softens syndrome?

Answer 6

ana
ro (ssa)
la (ssb)
rheumatic factor

Question 7

in what do ways are autoimmune diseases treated?

Answer 7

treat pain- hollistic, analgesics, saids

slow diseased progress - dmards (immune modulators) and biologics

steroids- reduce inflammation (short term)

Question 8

what may be needed when treated autoimmune diseases especially when taking systemic steroids?

Answer 8

proton pump inhibitors- protect GI- “prazoles”

Question 9

what are dmards used for?

Answer 9

to slow or stop disease progression- they suppress the entire immune system
- 1st line drugs for auto immune disease

Question 10

what are biological dmards used for?

Answer 10

to suppress part of immune system
-given as IV- as oral would be degraded by enzymes

Question 11

what are corticosteroids used for and what cytokines do they suppress?

Answer 11

reduce inflammation

• suppress IL1, IL2, IF gamma, TNF alpha

Question 12

what are examples of localised steroids?

Answer 12

hydrocortisone
triamcinolone q

Question 13

when would you give systemic antibiotics and what is an example?

Answer 13

at diagnosis or during acute flare ups

-prednisolone

Question 14

what are side effects of systemic steroids?

Answer 14

-peptic ulcers
-mania
-suicidal thoughts
-hypetension
-osteoporosis
-type 2 diabetes
-cushings syndrome
-mronj

Question 15

what would happen if patient was taken of steroids abruptly ?

Answer 15

adrenal insufficiency
low bp
death

Question 16

if a patient is taking steroids for more than 3 weeks and more than 40mg a week what should you do when stopping?

Answer 16

reduce to 7.5mg and then reduce slowly from there

Question 17

what should you test regularly if on longer term steroids?

Answer 17

-bp checks
-bone density checks

Question 18

what are the oral/dental issues of steroids?

Answer 18

-increase risk of infection- candidiasis
-risk of mronj as antiangiogenic drugs increase if on systemic steroids
-steroid prophylaxis