Lec 03: Autoimmune DIseases Flashcards

1
Q

What are the three requirements for a disease to be classified as autoimmunity?

A
  1. presence of an immune reaction specific for
    some self-antigen or self-tissue
  2. evidence that such a reaction is of primarily pathogenic in significance
  3. absence of another well-defined cause of
    disease
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2
Q

What is immunological tolerance?

A

unresponsiveness to an antigen as a result of

exposure of lymphocytes to that antigen

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3
Q

What are the two types of self-tolerance?

A

central and peripheral tolerance

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4
Q

What is the difference between central and peripheral tolerance?

A

central - deletion of self-reactive T & B cell clones
during maturation in the thymus or bone
marrow
peripheral - self-reactive T cells that escape thymic
deletion are silenced in the periphery

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5
Q

What mechanisms are utilized in central tolerance?

A

o Negative selection or Deletion
o Receptor Editing
o Development of regulatory T cells

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6
Q

What mechanisms are used in peripheral tolerance?

A

o Anergy (Prolonged or irreversible functional
inactivation of lymphocytes)
o Suppression by Regulatory T cells
o Deletion by activation-induced cell death
o Antigen Sequestration

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7
Q

What conditions may result in failure of peripheral tolerance?

A
  1. Breakdown of T cell anergy
  2. Failure of activation-induced cell death
  3. Failure of T cell-mediated suppression
  4. Molecular mimicry
  5. Polyclonal lymphocyte activation
  6. Release of sequestered antigens
  7. Exposure of cryptic self and epitope spreading
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8
Q

(T/F) The inheritance of susceptibility genes is the only factor that may produce autoimmunity.

A

F

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9
Q

What diseases are associated with polymorphisms in PTPN22?

A
Rheumatoid Arthritis, type 1 DM, and other
autoimmune diseases (most frequently implicated gene in autoimmunity)
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10
Q

Which disease is associated with polymorphisms in NOD-2?

A

Crohn’s disease

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11
Q

What are the general features of an autoimmune disease?

A

o tends to be progressive
o clinical and pathologic manifestations are determined by the nature of the underlying immune response
o different autoimmune diseases show substantial
clinical, pathologic, and serologic overlaps

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12
Q

What are the general characteristics of SLE?

A

o multi-system autoimmune disease
o presence of antinuclear antibodies
o characterized principally by injury to the skin, joints, kidney, and serosal membranes

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13
Q

What are antinuclear antibodies?

A

autoantibodies that react with protein or nucleic

acid in nucleus

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14
Q

What method is commonly used to detect antinuclear antibodies?

A

indirect immunofluorescence

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15
Q

What are the 4 categories of antinuclear antibodies?

A
  1. Antibodies to DNA
  2. Antibodies to histones
  3. Antibodies to nonhistone proteins bound to RNA
  4. Antibodies to nucleolar antigens
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16
Q

What is the substrate of dsDNA antibodies?

A

Crithidia (a protozoa with

a kinetoplast of pure dsDNA, without histone)

17
Q

What are the screening tests used in detecting SLE?

A

ANA - 99% sensitivity
Anti dsDNA - high specificity, sensitivity 70%
Anti- Sm - most specific antibody test, 30-40% sensitivity
Anti- SSA - present in 15% of patients with SLE and Sjogren’s syndrome
Anti- histone - Drug- induced lupus ANA antibodies

18
Q

What are the patterns of kidney injury in SLE?

A

minimal, mesangial, focal proliferative,

diffuse proliferative, membranous

19
Q

How are the affected blood vessels of those with SLE described?

A

“Onion skinning”

20
Q

What are the ACR Criteria for SLE Dx?

A

at least 4/11 of the ff.:
serositis, oral ulcers, arthritis, photosensitivity, blood disorder, renal disorder, antinuclear antibody, immunologic disorder, neurologic disorder, malar rash, discoid rash

21
Q

What drugs are used to manage SLE?

A

Hydroxychloroquine, NSAIDs, steroids

22
Q

(T/F) kidney transplant is a definitive treatment for lupus nephritis

A

F

23
Q

What is Sjogren’s syndrome?

A

Immunologic destruction of lacrimal and salivary

glands

24
Q

What are the two forms of systemic sclerosis?

A

o Diffuse scleroderma

o Limited scleroderma/ CREST Syndrome