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BioMed S2 R > 15. Immune System - Autoimmune Disorders > Flashcards

15. Immune System - Autoimmune Disorders Flashcards

1
Q

What are autoimmune disorders?

A

Conditions associated with an immune response against the body’s own tissues

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2
Q

What is autoimmunity?

A

A breakdown of the mechanisms responsible for self-tolerance

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3
Q

What are formed to fight self-antigens?

A

Autoantibodies
Cytotoxic T-cells

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4
Q

What does the antibody-antigen reaction lead to?

A

Complement activation
Inflammation
Tissue damage

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5
Q

Which genetic markers are linked with autoimmune diseases?

A

HLA: B27, DQ2, DR2, DR3, DR4

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6
Q

What digestive tract situation is linked with autoimmune diseases?

A

Increased intestinal tract permeability (leaky gut)

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7
Q

Systemic Lupus Erythematosus (SLE): definition

A

Chronic, inflammatory, autoimmune, multi-system disorder in which antibodies are formed against nuclear antigens

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8
Q

Systemic Lupus Erythematosus (SLE): pathophysiology

A

B-cell activation increasing IgG levels against components of cell nuclei

Inability to remove immune complexes from tissue
Complement is activated causing inflammation
Impaired T-cell regulation

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9
Q

Systemic Lupus Erythematosus (SLE): aetiology

A
  • Multifactorial interaction between various genetic and environmental factors
  • Higher oestrogen levels
  • Low vitamin D levels
  • Chronic bacterial infections common pre-diagnosis
  • Viral infections e.g. EBV
  • Smoking, silica dust (from concrete)
  • Oral contraceptive pill, HRT, stress, UV light, pesticides can all cause flare-ups
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10
Q

Systemic Lupus Erythematosus (SLE): signs and symptoms

A

Fever, malaise
Butterfly rash, photosensitivity, vasculitis (pain in fingertips), Raynaud’s syndrome (arteries in spasm)
Joint pain - peripheral (sym/asym) - hands, knees, elbows
Pleurisy, pericarditis, hypertension
Nephritis (nephrotic syndrome)
Lymphadenopathy, splenomegaly, anaemia, leukopenia

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11
Q

Systemic Lupus Erythematosus (SLE): diagnostics

A

Blood tests: anti-nuclear antibodies (ANAs), anaemia, elevated ESR and complement, anti-phospholipid antibodies

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12
Q

Systemic Lupus Erythematosus (SLE): allopathic treatment

A

Immunosuppressants
Corticosteroids
Sunscreen*
NSAIDs

*This has a consquence for Vit D deficiency

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13
Q

Rheumatoid Arthritis: definition

A

Autoimmune, chronic, systemic inflammation of the synovium
Potentially affects all organs (except brain)

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14
Q

Rheumatoid Arthritis: pathophysiology

A

RF (present in around 80% of sufferers) is an auto-antibody which is directed against a portion of IgG
Resultant immune complexes activate complement proteins leading to inflammation

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15
Q

Rheumatoid Arthritis: aetiology

A

Genetic markers - HLA-DR4 and DR1
Infectious agents e.g. rubella, EBV
Abnormal intestinal permeability, small intestinal bacterial overgrowth (SIBO)
Smoking

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16
Q

Rheumatoid Arthritis: signs and symptoms

A
  • Symmetrical/bilateral arthritis of small joints (hands and feet mostly)
  • Gradually spreads to more proximal structures
  • Progressive morning stiffness (> 1 hr)
  • Deformity of joints e.g. swan neck, ulnar deviation
  • Subcutaneous nodules around fingers/elbows
  • General malaise and fatigue
  • C1/C2 subluxation and compression of the spinal cord leading to paralysis and neurological complications
  • Kidney / pulmonary problems
17
Q

Rheumatoid Arthritis: allopathic treatment

A

Anti-inflammatories and immunosuppressants
Immunomodulators - methotrexate (hard drug, best avoided)
Surgery

18
Q

Rheumatoid Arthritis: epidemiology

A

Affects 1% of people worldwide; greater in women
Peak occurrence - 30-50 yrs old

19
Q

Ankylosing Spondylitis: definition

A

Systemic autoimmune disease associated with chronic inflammation of the spine and sacroiliac joints
Often leads to spinal fusion and stiffness

20
Q

Ankylosing Spondylitis: aetiology

A

Strong genetic association with HLA-B27 (present in 95% of patients)
Links with inflammatory bowel diseases and leaky gut
Urogenital or intestinal infections such as salmonella and shigella can cross react with HLA-B27

21
Q

Ankylosing Spondylitis: signs and symptoms

A

Typically begins with sacroiliac and lower lumbar spine pain, before progressing up spine
Associated with worsening morning stiffness
Lower back pain improves with activity
Lumbar lordosis flattens and patients often become kyphotic
Hip and heel pain common
20% suffer acute iritis* (eye infection)
Systemic symptoms - fever, fatigue, malaise

*linked to HLA B27

22
Q

Ankylosing Spondylitis: diagnostics

A

Bloods - elevated inflammatory markers (CRP, ESR), positive for HLA-B27
X-ray, MRI - to reveal characteristic bamboo spine

23
Q

Ankylosing Spondylitis: allopathic treatment

A

Anti-inflammatories
(NSAIDs and steroids)
Surgery in later stages

24
Q

Ankylosing Spondylitis: epidemiology

A
  • Age of onset typically 15-30 yrs old
  • More common in males
25
Q

Hashimoto’s Thyroiditis: definition

A

Autoimmune condition causing hypothyroidism

26
Q

Hashimoto’s Thyroiditis: pathophysiology

A

Thyroid gland gradually destroyed by a variety of cell- and antibody-mediated immune processes
Auto-antibodies develop that react with thyroglobulin and thyroid cells preventing the synthesis of thyroid hormones
Leading to low thyroid hormones - T4 and T3

27
Q

Hashimoto’s Thyroiditis: signs and symptoms

A

Tiredness, malaise, weight gain, cold intolerance, constipation, depression

Slow cognition, poor memory, low libido, deep voice, menstrual changes, muscle aches, arthralgia (joint pain)

Goitre, dry, brittle skin, thin hair, loss of eyebrows

Myxoedema (swelling often around eyes - deposition of polysaccharides which attract water)

28
Q

Hashimoto’s Thyroiditis: diagnostics

A

Physical - slow tendon reflexes, bradycardia
Blood tests - high TSH, low thyroid hormones
Barnes temperature test - below 36.6C may indicate hypothyroidism

29
Q

Hashimoto’s Thyroiditis: allopathic treatment

A

Levothyroxine - thyroid hormone replacement

30
Q

Graves’ Disease: definition

A

Autoimmune condition causing hyperthyroidism

31
Q

Graves’ Disease: pathophysiology

A

Increased IgG antibodies bind to TSH receptors and stimulate production of thyroid hormones

32
Q

Graves’ Disease: aetiology

A

Excessive iodine supplementation
Tumour - hypothalamic, pituitary

33
Q

Graves’ Disease: signs and symptoms

A

Nervousness, irritability, hyperactivity, unexplained weight loss, heat sensitivity, increased swelling

Insomnia, palpitations, muscle weakness, frequent bowel and bladder movements, diarrhoea, fatigue (only symptom similar to hypothyroidism)

Goitre (only sign similar to hypothyroidism), exophthalmos (bulging eyes), tachycardia, tremor, brisk tendon reflexes, lid lag

34
Q

Graves’ Disease: allopathic treatment

A

Carbimazole (to block thyroid activity)
Radioactive iodine (to destroy part of the thyroid gland*)
Beta-blockers (to manage tachycardia), surgery

*Can result in hypothyroidism

35
Q

What can be used to confirm increased intestinal permeability (leaky gut) ?

**Not on slides

A

Comprehensive stool analysis can show markers such as zonulin

36
Q

What is zonulin ?

Not on slides

A

A protein that plays a role in regulating the permeability of the intestinal mucosal barrier
Is is released in response to gluten or certain bacteria

37
Q

Systemic Lupus Erythematosus (SLE): natural treatment

A
  • Anti-inflammatory diet
  • Supplements: vitamin D3, antioxidants, alpha lipoic acid, EFAs.
  • Herbs, acupuncture and homeopathy.
  • Manual therapy for joint pain.
  • Stress reduction, e.g. meditation, breathing exercises, etc.
38
Q

Rheumatoid Arthritis: natural treatment

A
  • Nutrition: anti-inflammatory and reducing intestinal permeability: increase antioxidants,
  • Mediterranean diet / increase omega-3, Vit D3
  • Herbs for pain and inflammation and immune modulation: Turmeric, Boswellia, Devil’s Claw.
  • Homeopathy (e.g. Rhus tox) and acupuncture.
39
Q

Ankylosing Spondylitis: natural treatment

A

Nutrition (remove pathogenic
organisms / elimination diet / increase
vitamin D3 and antioxidants)
Herbs (antiinflammatory)
Homeopathy; acupuncture
Manual therapies to help prevent kyphosis

BioMed S2 R (34 decks)

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