Immune System Flashcards
DAMPs
danger-associated molecular patterns
unhealthy cells are recognized by immune system by these cues
PAMPs
pathogen-associated molecular patterns
immune system recognizes infectious microbes by these cues
T cells
contribute to cell mediated immunity to directly destroy infected cells
helper t cells
activate cytotoxic t cells and b cells
cytotoxic t cells
directly kill infected cells, release toxic substances
b cells
humoral immunity
produce antibodies that bind pathogens and mark them for destruction by t cells
cytokines
proteins immune system produces to trigger inflammation to fight pathogens
t cells are produced where?
thymus
b cells are produced where?
bone marrow
passive immunity
acquired immunity from an outside source like mother to child or from blood transfusion
active immunity
immune response to antigen
includes innate and adaptive immunity
achieve through fighting pathogen or vaccine
innate immunity
physical barriers to pathogens like skin
generalized, first line of defense
adaptive immunity
specific immune cells, cytokines, etc
antibodies
primary immune deficiency
born with an underactive immune system
acquired immune deficiency
disease weakens immune system
immune system hyperactivity
allergic reaction
autoimmune reaction
immune system turns on body
PT implications when seeing HIV pts in clinic
infection control - body fluids
HIV pathophys
infects CD4 T cells which fight infections
CD4 replicates and kills CD4 cells
immune system can’t produce T cells fast enough, get depleted and weakens immune system
stage I HIV infection
acute: 2-4 weeks after infection
flu like symptoms lasting days-weeks or asymptomatic
stage II HIV infection
clinical latency
test positive but asymptomatic
lasts 10-15 years with treatment, meds lower to undetectable level
stage III HIV infection
AIDS
rapid weight loss, night sweats etc etc constitutional symptoms
mouth sores, swollen lymph nodes, karposi’s sarcoma/nodules/plaques on skin
opportunistic infections
PT implications for treating HIV patient
immune compromise increases infection risk
higher comorbidities
aerobic/fitness level decline through disease progression
if hospitalized battling effects of bed rest
acute HIV infection PT treatment
lung secretions
aerobic fitness
normal ROM
posture
med-high intensity aerobic and resistance training
latent/chronic stages HIV infection PT treatments
mod-high intensity aerobic shown to improve immune system
resistance
balance
pain management
prevent contractures
ADLs
refer for cog/bxal therapy
fibromyalgia
widespread pain/tender spots, muscle aches, and fatigue for 3+ months without evidence of inflammation of tissue damage
autoimmune, nociplastic pain centrally mediated
risk factors for fibromyalgia
middle age, other autoimmune condition, female, traumatic event, repetitive stress injuries, viral infection, family hx, obesity
fibromyalgia clinical presentation
pain/stiffness widespread
fatigue
memory issues
headaches
muscle spasm
disturbed sleep
increased sensitivity to noise/light etc
also: GI, face pain, TMJ, tingling hands/feet
fibromyalgia comorbidities
raynaud’s
chest pain like angina
tendonitis
dyspnea
IBS
urinary urgency
dry eye
depression/anxiety
foggy cognition
PMS
weight gain
RA pain vs fibromyalgia pain distribution
RA: pain in joints of extremities
fibro: muscles in extremities and proximally
fibromyalgia diagnostic criteria
widespread pain index 7+ and symptom severity scale 5+ OR WPI 4-6 and SSS 9+
generalized pain in 4-5 regions
symptoms 3+ months
fibromyalgia management
non-pharm inteverntions for pain
CBT
antidepressants
aerobic/strengthening
acupuncture
hydrotherapy
meditation
differential of fibromyalgia
endocrine issue
illness
infection
inflammation
RA
RA risk factors
age 60+, female, genetic, smoking, never given birth
s/s of RA
slow onset, fatigue, progressive joint involvement, stiffness in morning, stiffness w prolonged sitting, BL symptoms
comorbidities: depression, weight loss comorbidity
diagnostic criteria of RA
SERIOUS acronym
swelling in 1+ joint
early morning stiffness
recurring joint pain
inability to move joint normally
obvious tenderness
unexplained fever
symptoms 2+ weeks
RA definition
inflammation of synovial membranes bilaterally in hand, wrist, feet
O-Sullivan functional classifications of RA
I: able to perform ADLs completely
II: able to perform usual self care/vocational activities, limited in avocational activites
III: able to perform usual self care, limited in vocational/avocational activities
IV: limited in ability to perform self care, vocational, and avocational activities
effect of RA on the joint surface
cartilage loss and progressive destruction
reduced joint space
FITTVP for RA exercise
F: 2x day, 5x week, 30 min
I: strength 60-80%, aerobic 60%
T: 3-6 months
type: water therapy, hand therapy, group exercise
polymyalgia rheumatica
widespread pain/stiffness coming on quickly over day(s), symmetrical
s/s polymyalgia rheumatica
morning achiness improving through the day
BL UE involvement
impaired overhead reach
joints not swollen
less common: fatigue, fever, poor appetite, weight loss
labs: high erythrocyte sed rate, CRP
polymyalgia rheumatica population
50+ years to 70
women
caucasian
polymyalgia rheumatica course/treatment
lasts 2-3 years then resolves on it’s own
use corticosteroids low dose for relief
symptom based therapy but no evidence for PT
DD of polymyalgia rheumatica
RC disease
DDD
fibromyalgia
endocrine disorder
parkinson’s
hypovitamiosis D
drug induced myopathy - statins
SLE
chronic, systemic, inflammatory disease
multisystem
discoid or systemic
discoid SLE
confined to skin, coin shaped lesions
systemic SLE
affects almost every organ/system with variable presentations
SLE risk factors
genetic, infections, UV light, extreme physical/emotional stress, pregnancy
adult women, male children
20-40s
environment
hormone disturbance
some meds
s/s SLE
skin: butterfly rash, hair loss, light sensitive
MSK: arthritis, BL
neuro: peripheral neuropathy, decreased DTR, abn sensation
mouth: sores, numbness
low grade fever
fatigue
pulm: pleurisy, chest pain, difficulty breathing, cough
raynaud’s
kidney involvement
SLE management
NSAIDs, steroids, cytotoxic drugs, antimalarials
education
activity management
stress reduction
sleep hygiene
avoid foods that increase vitamin D
smoking cessation
aerobic exercise 60% VO2max
ROM
energy conservation
scleroderma types
localized: affects skin and not major organs
systemic: affects skin and major organs
systemic scleroderma
skin thickening - tightening and loss of ROM
chronic joint pain and inflammation
raynaud’s
subcategories of limited or diffuse
scleroderma risk factors
any age/race
mostly women
localized tends to present before age 40
systemic tends to present between 30-50
limited scleroderma distribution
head and distal extremities
diffuse scleroderma distribution
all over the body with emphasis on skin changes in the torso
sine scleroderma distribution
organ involvement with no skin involvement
acronym for scleroderma symptoms
CREST
Calcinosis: ca deposits in skin
R: raynaud’s
E: esophegeal dysfunction
S: sclerdactyly
T: telangiectasias: capillary dilation, red marks on skin surface
s/s diffuse scleroderma
major organs: GI, lungs, kidney, heart
renal disease common
cardiomyopathy/pericarditis, arrhythmias
skin thickening trunk, UE/LE
MSK pain/flexion contractures
management of scleroderma
NSAIDs, lotion, symptom based PT
immune suppressants
PT goals: manage pain, improve str/aerobic capacity, maintain ROM, maintain ADLs
reactive arthritis/reiter’s syndrome
painful, inflammatory arthritis as reaction to bacterial infection
link to chlamydia and HLA gene
reactive arthritis s/s
abrupt onset
eye inflammation, self limiting for a few days/weeks
urinary frequency
pain/swelling joints, esp feet
heel pain
toes/finger swelling
lesions on toes, nails, feet
LBP worse at night or in morning
low grade fever
reactive arthritis risk factors
males 20-50
HLA-B27 gene
weakened immune system
reactive arthritis treatment
NSAIDs early
RA meds for chronic
psoriatic arthritis
autoimmune condition of skin with raised red patches and scaly white patches plus persistent joint inflammation leading to joint damage
psoriatic arthritis risk factors
30-50
equal gender risk
15-30% with psoriasis will develop
associated with anemia and fatigue
s/s psoriatic arthritis
pain/stiff/swollen joints
UL/BL, single or multiple
dactylitis swollen fingers/toes
spondylitis
progressive joint damage if not managed
Gout
inflammatory arthritis
very painful
caused by hyperuricemia - uric acid build up as crystals
flares in single joints
risk factors for gout
male
obese
CHF, HTN, metabolic syndrome, diabetes
protein rich diet, acl, high fructose
patterns of autoimmune conditions
soft tissue/joint pain
stiffness
swelling
weakness
raynaud’s
sleep disturbances
fatigue
stiffness 1+ hours after waking and after prolonged sitting
s/s requiring immediate medical attention
shock, hoarse voice, difficulty breathing, chest pain
new onset joint pain after surgery
blue color + very tender joint for infection
refer to physician w these s/s
new onset joint pain within 6 weeks of surgery
symmetric swelling
developing or progressing neuro symptoms after infection
evidence of spinal cord compression
incontinence with ankylosing spondylitis
what motion produces arthritis pain
AROM and PROM, worse in active
risk of what fracture with RA or AS?
cervical, atlantoaxial subluxation
