Pathophysiology of Inflammation III

Question 1

In terms of regulation of inflammation, what are the 2 types?

Answer 1

Pro - Inflammatory

Anti - Inflammatory

Question 2

What are the 2 main triggers of autoimmune disease?

Answer 2

Environment

Genetics

Question 3

In terms of environmental triggers, name some examples.

Answer 3

Triggers // Infection // Microbiome // Tissue Injury

Question 4

In terms of genetic triggers, name some examples.

Answer 4

Multiple genetic polymorphisms in immune related genes IMPAIR immune regulation.

Question 5

In terms of auto reactive lymphocytes, what are the 2 types of cells?

Answer 5

Auto - reactive T - cells

Auto - reactive B - cells.

Question 6

What are auto - reactive lymphocytes?

Answer 6

Reacts to NORMAL tissues -> attacks joints // pancreas

Question 7

What does the auto - reactive T - cells do?

Answer 7

Attack the tissues directly.

Question 8

What does the auto - reactive B - cells do?

Answer 8

Autoantibodies made which can attack your own tissue cells.

Question 9

What are the stages of an autoimmune disease?

Answer 9

Initiation
Propagation 
Resolution 
Propagation 
Resolution

Question 10

In terms of autoimmune diseases, what happens to the tissues and organs over time?

Answer 10

Over time, the progressive damage of the affected tissues and organs REDUCES.

Question 11

Which type of inflammatory are T - Reg cells?

Answer 11

T - Reg cells are anti - inflammatory.

Question 12

Which type of inflammatory are T - Pro cells?

Answer 12

T - Pro cells are pro - inflammatory.

Question 13

What is the purpose of CCP - antibodies?

Answer 13

These attack the tissues in the body as it is acute inflammation and gives TISSUE DESTRUCTION.

Question 14

Why when doing an x - ray can the hands look normal?

Answer 14

This is because the disease could be at the early stages and therefore, the symptoms could be minor // show up elsewhere.

Question 15

What is the erythrocyte sedimentation rate (ESR)?

Answer 15

This the type of blood test which measures how quickly RBC’s settle at the bottom of a test - tube which contains a blood sample.

Question 16

What is the units for ESR?

Answer 16

mm / hr

Question 17

What indicates inflammation during an ESR?

Answer 17

A faster rate than normal indicates inflammation.

Question 18

What happens when there is a negative charge on red blood cells?

Answer 18

Negative charge results in RBC’s repelling.

Question 19

What happens when there is a positive charge on red blood cells?

Answer 19

Positive charge results in fibrinogen causing RBC’s to stick together.

Question 20

In terms of chronic inflammation, what happens to the proteins?

Answer 20

There is a change in the proteins.

Question 21

What are the 2 main environmental triggers for CCP antibodies?

Answer 21

Smoking

Gum Disease

Question 22

What is the process triggered by gum disease // smoking?

Answer 22

Deamination of arginine. 
Releases PAD (protein arginine deaminase). 
Some of the arginine goes to the citrulline and this is when the amino acids change and thus, TRIGGER an anti - cc antibody. 
These attack the joints and thus, ARTHRITIS occurs.

Question 23

What is the purpose of PAD? (protein arginine deaminase.)

Answer 23

These catalyse the hydrolysis of peptides - arginine.

Question 24

What is the first stage of RA?

Answer 24

No damage -> inflammation symptoms arise.

Question 25

What is the second stage of RA?

Answer 25

Symptoms of inflammation causes DAMAGE to the joint cartilage.

Question 26

What is the third stage of RA?

Answer 26

Damage extends from the cartilage to the bones -> this is known as EROSION.

Question 27

What is the fourth stage of RA?

Answer 27

NO inflammation in the joints BUT the joints do not work.

Question 28

What is the aim of anti - inflammatory drugs?

Answer 28

Reduce symptoms.

Question 29

What is the aim of disease modifying drugs?

Answer 29

Prevent long term tissue damage.

Question 30

What is the aim of physiotherapy // occupational therapy?

Answer 30

Maintain function.

Question 31

What is hypersensitivity?

Answer 31

This is an excessive // immune reaction to a foreign substance not otherwise considered to be noxious. "Undesirable reactions are produced"

Question 32

What is Type I hypersensitivity?

Answer 32

Immediate // Anaphylatic. | It is a form of an allergy and its exposure is via ingestion // infection // inhalation.

Question 33

What is anaphylaxis?

Answer 33

This is a combination of oedema and airway constriction. This prevents the tissues from getting oxygen.

Question 34

Give some examples of diseases caused by type I hypersensitivity.

Answer 34

Conjunctivitis // Angio - Oedema // Eosinophilia // Rhinitis

Question 35

What is the mechanism of action for type I hypersensitivity?

Answer 35

Plasma cells secrete IgE (immunoglobulin E) antibodies. Binds to the mast cells and thus, releases histamines. Activates an immune memory when exposure to allergens causing inflammation at the site as the blood flow to the affected tissues is affected.

Question 36

What are the symptoms of life - threatening acute reaction?

Answer 36

``` Swelling = Angiodema Fast heartbeat Blood pressure can DROP. Collapsing Confusion Wheezing Clammy skin Restricts the airways. ```

Question 37

What are the ways of treating anaphylaxis?

Answer 37

Anti - Histamine Adrenaline Injection Corticosteroids

Question 38

Explain more about the adrenaline injection. (Known as an Epi - Pen).

Answer 38

Vasoconstrictor which is an injection which contains epinephrine. This NARROWS the blood vessels and opens the airways in the lungs.

Question 39

What is the purpose of corticosteroids in treating anaphylaxis?

Answer 39

Used for the 2nd round of inflammation. | BLOCKS histamine = BLOCKS vasodilators.

Question 40

Why may an epi - pen NOT work?

Answer 40

May not have FULLY circulated around the body.

Question 41

How can chronic type - 1 hypersensitivity be triggered?

Answer 41

House Dust mite. Fungal Spores. Animal Dander.

Question 42

In terms of preventing type - 1 hypersensitivity what is done?

Answer 42

Maintaining immunosuppression = NO inflammation. | Give corticosteroids // desensitisation.

Question 43

In terms of treating type - 1 hypersensitivity what is done?

Answer 43

Control flares or attacks with corticosteroids.

Question 44

What is type II antibody dependent cytotoxic hypersensitivity?

Answer 44

Antibody mediated process in which IgM and IgG antibodies are directed AGAINST antigens on cells.

Question 45

What does high levels of IgM indicate?

Answer 45

Sign of a new infection.

Question 46

What is the most common type of immunoglobulin found in the body?

Answer 46

IgG.

Question 47

What is type III complex mediated hypersensitivity?

Answer 47

Reactions are characterised by tissue damage -> Caused by the activation of complement in response to antigen - antibody complexes which are deposited in the tissues.

Question 48

What is type IV cell mediated // delayed hypersensitivity?

Answer 48

This is when the response is mediated by effector t - cells // macrophages and leukocytes. They infiltrate a site of the antigen exposure and induce a delayed form of inflammatory tissue damage.