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Flashcards in Autoimmune Pathology Deck (81):
1

The immune response is characterized by a balance of

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

2

Type I Hypersensitivity

-IgE is produced instead of IgG

3

Type I Hypersensitivity Reactions

-hay fever
-allergic rhinitis
-extrinsic asthma
-anaphylactic shock

-Local and potential systemic response with exposure to allergen

4

Type II Hypersensitivity

-cytotoxic reaction to self-antigens

5

Type II Hypersensitivity Reactions

-blood transfusion reactions
-hemolytic disease of newborn
-autoimmune hemolytic anemia
-myasthenia gravis

6

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

-exogenous pathogens
-endogenous body tissues

7

Type III Hypersensitivity

-immune complex disease
-antigen-antibody complexes deposit in tissues around small blood vessels-->vasculitis

8

Vasculitis Affects the:

-skin
-joints
-kidneys
-pleura
-pericardium

9

Type IV Hypersensitivity

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

10

Type IV Hypersensitivity Reactions

-graft vs host disease
-transplant rejection

11

Antigens processed by ____ and presented to ____

-macrophages
-T cells

12

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

-T4
-T8

13

Cause of Autoimmune Disorders

(Auto-Antigens)

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

14

Cause of Autoimmune Disorders

(Antigenic Stimulation/Suppressor T Cell Suppression)

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

15

Cause of Autoimmune Disorders

(Genetics)

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

16

Autoimmune disorders

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

17

Auto-Antibodies Contribute to:

-Diabetes: T-cells attacking pancreas
-RA: auto-antibody called rheumatoid factor

18

Examples of Autoimmune Disorders

-SLE
-Psoriasis
-Psoriatic Arthritis
-Grave's Disease

19

Grave's Disease

-antibodies against thyroid cell membrane, including TSH receptors

20

Immune reactions are characterized by:

-inflammation which may be chronic
-results in damage to normal tissues

21

Areas affected by autoimmune disorders

-connective tissue in/around joints inflammed
-inflammed muscles
-pericardium
-pleura
-brain

22

Lab Tests of Autoimmune Diseases Reveal

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

23

Clinical Manifestations of Autoimmune Disorders

-synovitis
-pleuritis
-myocarditis
-endocarditis
-pericarditis
-peritonitis
-vasculitis
-myositis
-skin rash
-nephritis
-alterations in connective tissue
-constitutional symptoms

24

Constitutional Symptoms

-fatigue
-malaise
-myalgias
-arthralgias

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