Screening for Autoimmune Disorders Flashcards
1
Q
What is the definition of autoimmune disorders
A
- conditions in which the immune response is directed against the body
- self-destructive
- > 56 autoimmune disease
- organ specific
- systemic
2
Q
What are the different types of autoimmune disorders?
A
- Organ-specific
- systemic
3
Q
What are the potential etiologies of Autoimmune disorders
A
- idiopathic
- genetic
- hormonal
- environmental
4
Q
What are some common lab test results common with autoimmune diseases
A
- thrombocytopenia
- leukopenia
- increased or decreased immunoglobin (not used alone)
- rheumatoid factor
- antinuclear antibodies: abnormal protein
- increase muscle enzymes
5
Q
Common clinical features of autoimmune disorders
A
- pleuritis
- myocarditis
- endocarditis
- pericarditis
- vasculitis
- synovitis
- myositis
- skin rash
- altered connective tissue
- peritonitis
- constitutional symptoms (usually initially)
A lot of inflammation
6
Q
What is intravenous immunoglobin therapy
A
- individual immunoglobulin G (IgG) has antibodies against many types of proteins and auto-antibodies
- IVIg: pooled IGg from donors
- modulates immune response: acute and chronic use
7
Q
What is polymyositis/dermatomyositis and what is it assoicated with
A
- most common idiopathic disease of muscle
- can be idiopathic
- can be assoicated with cancer (breast, lung, ovarian, colon, gastric)
- can be assoicated with other diseases: RA, lupus, scleroderma
8
Q
What is the pathophysiology for polymyositis/dermatomyositis and symptoms of the disease
A
- Suspected mechanism: T-helper cells attack muscle fibers
symptoms:
- weakness, usually starts proximally; symmetrical (often starts in LE)
- can be rapid but is usually insidious
- malaise and fatigue more common than weakness
- may eventually have cardiac and pulmonary involvement
9
Q
What is the difference between polymyositis/dermatomyositis
A
- dermatomyositis = skin involvement
- rash is typically on eyelids, face, and extremities/exentsor surface
10
Q
polymyositis/dermatomyositis Diagnostic testing
A
- increase in CPK, CK, or CK-MB
- positive antibody test
- muscle inflammation can be seen on an MRI
- EMG changes related to fibrotic changes, muscle membrane irritability, weakness, denervation/reinnervation
11
Q
What are likely EMG findings for polymyositis/dermatomyositis
A
- increased insertional activity
- spontaneous activity at rest
- with activity: reduced amplitude of M waves, polphasic waves, complex repetitive discharge
12
Q
polymyositis/dermatomyositis treatment
A
- medication: corticosteriods, immunosuppressants, intravenous immoglobulin therapy
- exercise/rest: distrubted practice works well
- prognosis improves with good medical management
13
Q
Polymyalgia rheumatic
who does it affect and what is it assoicated with
A
- affects people over 55 esp over 80 years old
- related to virus, stress, autoimmune
- associated with high ESR
- muscle pain and stiffness vs joint pain
- usually self-limiting
- assoicated condition: giant cell arteritis; inflammation of medium arteries (may require medication with this)
14
Q
Polymyalgia rheumatic
signs and symptoms
A
- appear suddenly
- proximal muscles
- muscle stiffness in morning
- weakness, fatigue, malaise
- headahces
- vision changes
- depression
- weight loss
- jaw pain dysfunction but not TMJ
15
Q
Chronic Inflammatory demyelinating polyneuropathy (CIDP) cause/assoicated with
A
- cause is unknown
- appears to be related to a trigger such as acute illness or surgery, ICU, trauma
- assoicated with chronic disease: diabetes, HIV, lupus, Lymphoma, chronci hepatitis, thryrotoxicosis
16
Q
Chronic Inflammatory demyelinating polyneuropathy (CIDP) signs and symptoms
A
- weakness or paralysis
- paresthesias
- Ms atrophy
- fatigue
- cranial nerve dysfunction
- impaired motor control
- areflexia
LMN probelm
17
Q
Chronic Inflammatory demyelinating polyneuropathy (CIDP) treatment
A
- medical treatment: steriods, immunosuppressants, plasma exchange or plasmapheresis, IVIg
- PT may have a longer duration of care or multiple epsiodes
- electrodianostic findings: NCV = increased latency or EMG abnormal findings
18
Q
medical interventions for autoimmune disease
A
- intravenous immunoglobulin therapy
- plasma exchnage plasmapheresis (not from donors from ones own blood)
19
Q
What is lambert-eaton myasthenic syndrome (LEMS)
A
- frequently assoicated with autoimmune disorders
- antibodies attack Ca++ channels at presynaptic junction, impairing ACh release
- Assoicated with cancer esp small cell lung cancer
20
Q
LEMS symptoms
A
- proximal weakness usually affecting legs first
- may see slight increase in strength with repeated contractions
- hyporeflexia
- autonomic dysfunction: dry mouth, constipation
- electrodiagnostic findings
21
Q
LEMS treatments
Lambert-Eaton myasthenic syndrome
A
- plasmapheresis/plasma exchange
- intravenous immunoglobulin therapy (IVIg)
- prednisone
- acetylcholinesterase inhibitors
- aminopyridines (potassium channel blockers)*
*K+ and Ca++ work together so blocking K+ allows C++ to be released
22
Q
PT exam and intervention for autoimmune disease contains?
A
- outcome measure: functional endruance
- strength exam
- functional mobility
- aerobic capacity training
23
Q
Guillain Barre Syndrome: what is it
A
- acute inflammatory polyneuropathy
24
Q
Guillain Barre Syndrome
incidence
A
- annual incidence 1-2 per 100,000 world wide
- males and females equally affected
- most common in people ages 30-50 years
- 20% of case < 20 years
25
GBS etiology
- recent infection thought to cause an auto-immune reponse
- ie: respiratory virus or GI virus
- auto-immune respones directed towards: myelin or axon of peripheral nerve
26
GBS: what can it be refered to as when it is directed towards myelin vs axon
- myelin: acute inflammatory demyelinating polyneuropathy
- axon: acute motor axonal neuropathy or acute motor and sensory axonal neuropathy
27
Guillain Barre Syndrome: signs and symptoms
- paresthesia in hands and feet
- bilateral, symmetrical weaknes; most often progresses distal to proximal
- usually starts in lower legs and progresses to arms and face; cranial nerve involvement
- respiratory muscles can be affected; may need mechanical ventilation
28
Guillain Barre Syndrome: diagnosis
- diagnosis based on progressive BUE and BLE weakness with areflexia
- electrodiagnostic findings
29
GBS progression
| timeline
- symptoms usually progress over ~ 2 weeks
- duration of illness usually about 12 weeks
- most patients start to improve about 2-4 weeks after onset
- most recovery occurs in first 2 years
- may show improvement for up to 10 years
30
Guillain Barre Syndrome: prognosis
- 80% of patients are able to walk after 6 months
- 50% have some residual neurological deficits
- 15% have continued activity limitations
- ~5% die of secondary organ failure or complications
31
# Guillain Barre Syndrome
PT exam and intervention
- outcome measures
- complications related to immobility
- pain fatigue
- overwork weakness
32
Myasthenia Gravis
- autoimmune syndrome
- caused by antibodies to the ACh receptors
- results in a decrease in the number of receptors
33
Myasthenia gravis: symptoms and patient population
| what muscles do the weakness effect, how does it vary and population
- weakness of eyes, mouth, throat, and limbs
- symptoms variable within a single day
- more apparent when the person is tired
- may also affect the respiratory muscles
- common in young adult women and older men
34
# Myasathenia gravis
treatment
- removal of thymus gland (if assoicated with thymoma)
- plasmapheresis
- IVIg
- steriods
- acetylcholinesterase inhibitors
35
# Myasthenia gravis
PT exam and intervention
- outcome measures: functional endurance
- strength exam
- functional mobilty
- aerobic capactiy training
