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Autoimmune Pathology Flashcards

1
Q

The immune response is characterized by a balance of

A

-chemical messengers that are made by inflammatory cells and promote other cells to incr/decr immune response

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2
Q

Type I Hypersensitivity

A

-IgE is produced instead of IgG

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3
Q

Type I Hypersensitivity Reactions

A
  • hay fever
  • allergic rhinitis
  • extrinsic asthma
  • anaphylactic shock

-Local and potential systemic response with exposure to allergen

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4
Q

Type II Hypersensitivity

A

-cytotoxic reaction to self-antigens

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5
Q

Type II Hypersensitivity Reactions

A
  • blood transfusion reactions
  • hemolytic disease of newborn
  • autoimmune hemolytic anemia
  • myasthenia gravis
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6
Q

Type II Hypersensitivity can also occur with a cross reaction between ____ & _____

A
  • exogenous pathogens

- endogenous body tissues

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7
Q

Type III Hypersensitivity

A
  • immune complex disease

- antigen-antibody complexes deposit in tissues around small blood vessels–>vasculitis

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8
Q

Vasculitis Affects the:

A
  • skin
  • joints
  • kidneys
  • pleura
  • pericardium
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9
Q

Type IV Hypersensitivity

A

-delayed hypersensitivity such as contact dermatitis with exposure to allergens such as poison ivy, adhesive, latex

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10
Q

Type IV Hypersensitivity Reactions

A
  • graft vs host disease

- transplant rejection

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11
Q

Antigens processed by ____ and presented to ____

A
  • macrophages

- T cells

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12
Q

___ & ____ cells respond and recruit lymphocytes, monocytes and macrophages

A
  • T4

- T8

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13
Q

Cause of Autoimmune Disorders

Auto-Antigens

A
  • drugs produce several autoimmune responses
  • photosensitivity can cause allergic reactions in some pts
  • trauma, infections, emotional distress can be triggers for some autoimmune diseases
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14
Q

Cause of Autoimmune Disorders

Antigenic Stimulation/Suppressor T Cell Suppression

A
  • antigenic stimulation results in antibody formation, activating T cells
  • autoimmune reaction is normally held in check by suppressor T-cells.
  • Suppressor T-Cell Suppression
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15
Q

Cause of Autoimmune Disorders

Genetics

A
  • women>men

- higher incidence of same type of auto-antibodies or similar autoimmune diseases in relatives

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16
Q

Autoimmune disorders

A

–condition where immune system produces auto-antibodies to an endogenous antigen with injury to tissues

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17
Q

Auto-Antibodies Contribute to:

A
  • Diabetes: T-cells attacking pancreas

- RA: auto-antibody called rheumatoid factor

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18
Q

Examples of Autoimmune Disorders

A
  • SLE
  • Psoriasis
  • Psoriatic Arthritis
  • Grave’s Disease
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19
Q

Grave’s Disease

A

-antibodies against thyroid cell membrane, including TSH receptors

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20
Q

Immune reactions are characterized by:

A
  • inflammation which may be chronic

- results in damage to normal tissues

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21
Q

Areas affected by autoimmune disorders

A
  • connective tissue in/around joints inflammed
  • inflammed muscles
  • pericardium
  • pleura
  • brain
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22
Q

Lab Tests of Autoimmune Diseases Reveal

A
  • thrombocytopenia
  • leukopenia
  • immunoglobulin excesses or deficiencies
  • antinuclear antibodies
  • rheumatoid factor
  • cryoglobulins
  • false-positive
  • serologic tests
  • elevated muscle enzymes
  • alterations in seru complement
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23
Q

Clinical Manifestations of Autoimmune Disorders

A
  • synovitis
  • pleuritis
  • myocarditis
  • endocarditis
  • pericarditis
  • peritonitis
  • vasculitis
  • myositis
  • skin rash
  • nephritis
  • alterations in connective tissue
  • constitutional symptoms
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24
Q

Constitutional Symptoms

A
  • fatigue
  • malaise
  • myalgias
  • arthralgias
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25
Management of Autoimmune Disorders
- suppression of immune system - palliative management of symptoms - immunoablation then stem cell transplantation - possibility of vaccines - gene therapy
26
Examples of Autoimmune Disorders
- addison's disease - crohn's disease - chronic active hepatitis - DM - primary biliary cirrhosis - grave's disease - Hashimoto's disease - Ulcerative Colitis - Giant cell arteritis - hemolytic anemia - idiopathic thrombocytopenia - polymyositis - dermatomyositis - post-viral encephalitis - amyloidosis - ankylosing spondylitis - mixed connective tissue disease - fibromyalgia - MS - polymyalgia rheumatica - progressive systemic sclerosis - psoriasis - Reiter's syndrome - RA - Sarcoidosis - Sjogren's Syndrome - SLE
27
Rheumatism
- any disorder marked by inflam, degen or metabolic derangement of connective tissue, especially joints - pain, stiffness, limited movement
28
Gout
- recurrent acute/chronic arthritis of peripheral joints that results from hyperuricemic body fluids - leads to formation of deposits in joints, soft tissue and kidneys
29
Diagnosis of Gout
- synovial fluid assessment | - elevated serum uric acid
30
Management of Gout
- may improve with weight loss & decreased consumption of alcohol & purines - NSAIDs - rest/protect joints
31
Psoriatic Arthritis
- RA-like arthritis associated with psoriasis of skin/nails - in people with psoriasis - painful, inflamed joints
32
Juvenile RA
- chronic inflammatory, systemic disease | - damage to connective tissue and viscera
33
RA
- chronic, systemic disorder | - affects synovial membrane and articular cartilage of entire body
34
RA Imaging
- X-ray | - marginal bony erosion
35
RA usually affects joint
-symmetrically
36
RA commonly affects
- wrists - hands - elbows - shoulders - knees - ankles
37
Smoking increases risk of:
-RA
38
Anklylosing Spondylitis
-inflam of axial skeleton & large peripheral joints
39
Initial Symptom of Anklylosing Spondylitis
- insidious onset of LBP, buttock or hip pain - decreased chest excursion & spinal mobility - decreased Lumbar lordosis
40
After initial inflammation of Anklylosing Spondylitis
- SI joints fuse - leaves no trace of joint surfaces - then spine fuses (bamboo spine)
41
Treatment of Anklylosing Spondylitis
- NSAIDs for pain - bisphosphonate drugs for severe back pain - stretching - aerobic ex's - breathing exercises - trunk extensor strength - pain free rotation
42
Scleroderma | systemic sclerosis
- chronic disease - diffuse fibrosis - degenerative changes - vascular abnormalities of skin, articular surfaces, internal organs (GI, lung, heart, kidney)
43
Early Manifestation of Scleroderma
-bilateral symmetric swelling of fingers and hands
44
In Scleroderma, edema is replaced by ______ in a few weeks to several months resulting in ________
- induration | - thick, hard skin
45
In Scleroderma skin thickness spreads rapidly within _____ to _____
- months | - forearms, upper arms, face, trunk
46
Scleroderma Fingertips
- taut - shiny - thickened - contractures of hands
47
Scleroderma Profile
- female> male (5:1) - age 30-50 - could be after severe emotional shock
48
Pathogenesis of Scleroderma
- widespread vasculopathy - fibrosis - relentlis deposition of collagen in blood vessels - connection between vasculopathy and skin fibrosis not understood
49
3 Stages of Scleroderma
- edematous stage - sclerotic stage - atrophic stage - skin calcification (stage 4)
50
Edematous Stage
-bilateral non-pitting edema in fingers/hands
51
Sclerotic Stage
- skin taut, waxy and smooth | - appears bound to underlying tissue
52
Atrophic Stage
- skin atrophies - contractures - ulcerations at joints
53
Classification of Scleroderma
- Systemic - Localized - overlap (associated with PD/DM) - diffuse (rapid progressing)
54
Systemic Scleroderma
-skin thickening in distal extremities and face
55
Localized Scleroderma
- single/multiple plaques without fibrosis | - single/multiple bands involving skin and deeper tissue
56
Clinical Manifestations of Scleroderma
- Cardiovascular: HTN - Joints: arthritis - Lungs: interstitial fibrosis - GI: esophageal dysfunction - Kidney: leads to HTN; renal failure, death - CREST Syndrome
57
CREST Syndrome
- Calcinosis - Raynaud's phenomenon - Esophageal dysmobility - Sclerodactyly - Telangiectasia
58
Raynaud's Phenomenon
- Abn vasoconstriction followed by vasodilation - pale, cool and painful-->red - agg by cold, vibratory forces, tobacco use
59
Scleroderma Management
- NSAIDs for pain - Penicillamine: slow thickening - Immunosuppressants
60
PT Management of Scleroderma
- prevent skin damage - prevent infections - wound care - avoid excessive bathing/moisturizing creams with glycerin - strenghtening - ROM - soft tissue mob (careful) - aquatic theray - joint protection/splints
61
Exercise for Scleroderma
- aerobic - endurance - monitor BP
62
Scleroderma Prognosis
- variable - can be fatal - worse for Sx with heart, lung, kidney damage
63
SLE
- systemic lupus erythematosus - chronic inflam connective tissue disorder of unknown origin that involves joints, kidneys, serous surfaces, vessel walls
64
SLE Profile
- young women - 15-40 years old - children - black, asian, native americans
65
Cause/risk factors of SLE
-familial link -genetic susceptibility -triggered by endog/exogenous factors (stress, infection, exposure to sunlight, certain drugs)
66
Pathogenesis of SLE
- disease of generalized immunity - body produces antibodies against tissues - nonspecific inflammation
67
Clinical Manifestations of SLE
- variable - Malar (butterfly) rash - discoid lesions - arthritis, arthralgia - headaches - irritability - depression - emotional instability - psychosis - seizures - CVA - cranial neuropathy - peripheral neuropathy - organic brain syndrome - tachycardia - pneumonitis - HTN - thrombosis risk - myocarditis - kidney failure - altered leels of RBC, WBC, throbocytes - fever - weight gain - fatigue
68
Discoid Lesions
- SLE - raised red, scaling plaques - neck, face, chest
69
Management of SLE
- NSAIDs for pain - no corticosteroids - anticoagulants - immunosuppressants - immunizations to decr infection risk - organ specific meds
70
PT with SLE
- ex's to prevent Mm weakness/fatigue - avoid sunlight - stress management - avoid alcohol - monitor signs of infection/necrosis - monitor renal involvement
71
Fibromyalgia
- chronic muscle pain syndrome | - lowered threshold for noxious stimuli
72
FMS
-fibromyalgia syndrome
73
Fibromyalgia can be associated with
- hypothyroidism - RA - SLE - chronic fatigue syndrome
74
Fibromyalgia Profile
- women>men - age 14-85 - less in trained athletes
75
Risk Factors for Fibromyalgia
- prolonged anxiety - stress - trauma - rapid steroids withdrawal - hypothyroidism - extracapsular silicone (breast implants) - non-viral infections
76
Cause of Fibromyalgia
- diet - infection - sleep disorder - occupational - seasonal/environmental influences - adverse childhood experiences - sexual abuse - psychological distress
77
Fibromyalgia Pathogenesis
DISTURBANCES IN: - hypothalamic-pituitary-adrenal axis - ANS - reproductive hormone axis - immune system
78
Fibromyalgia and Exercise
-blood doesn't flow to exercising muscles
79
Diagnostic Criteria
- widespread pain index & symptom severity scale - at least 3 months - rule out other causes - 18 specific points on body
80
Clinical Manifestations of Fibromyalgia
- multiple tender points & muscle pain - disturbed sleep - morning fatigue/stiffness - swelling/numbness - chronic headaches - IBS - Raynaud's - Dysmenorrhea-painful - exercise intol - weakness
81
Management of Fibromyalgia
- Thyroid hormone - stress management - pain management - drug therapy (multimodal) - modalities for pain - cognitive therapy - aerobic ex's - aquatic therapy - gentle exercise - monitor for post-exertional muscle pain - monitor overuse syndromes

Medical Conditions II (34 decks)

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