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autoimmunity Flashcards

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1
Q

autoimmunity

A

multifaceted: many characteristics that go along with the disease; affects many parts of the body

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2
Q

autoimmunity is a quantitative disorders and you must continuously

A

checked for level of antibody or t cell involvement

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3
Q

environmental factors that play a role

A

Exposure to certain medications, chemicals, UV light, certain poisons can trigger it

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4
Q

what gender is more prone to autoimmune disorders

A

women

-around age 40

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5
Q

antigenic mimicry

A

Introduction of exogenous antigen but looks similar to endogenous antigen and thought once immune system gets turned on to fight exogenous antigen doesn’t get turned off because finding endogenous antigens

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6
Q

what sites in immune system are more prone to autoimmunity

A

privileged sites
- avascular site that is not normally seen by the immune system

-happens when injury to these areas now immune system reacts to it

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7
Q

theory of autoimmunity

A

Some of reacting t and b cells toward self antigens never get destroyed

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8
Q

autoimmunity classified as either

A

multiple organ (systemic) or organ specific

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9
Q

SLE stands for

A

Systemic Lupus Erythematosus

-multi system
-chronic infections

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10
Q

what ethnicity is SLE highest

A

african and asian

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11
Q

lupus patients have presence of

A

HLA A1, B8, or DR3

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12
Q

what heightens lupus

A

○ Sunlight- photosensitivity
○ Medications
○ Stress
○ Certain hormones

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13
Q

in lupus antibodies get formed to

A

nuclear antigens – then get antigen antibody complex of intermediate size (hardest size for immune system to completely clear)

-trapped in many organs and fall on glomerular basement membrane

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14
Q

what is lupus often misdiagnosed as

A

RA

-cross react for some testing procedures

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15
Q

classic symptoms of RA

A

butterfly rash across the face or wolf like rash

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16
Q

first symptoms of lupus

A

stiffness of small joints

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17
Q

when there is kidney dysfunction in lupus what is seen on fluorescence

A

bumpy pattern

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18
Q

examples of autoantibodies that can be seen in lupus

A

double stranded DNA
histone complex
lymphs
RBCs
platelets
phospholipids
lupus anticoagulant

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19
Q

theories of lupus

A
  • Believed that apoptosis of self reacting of t and b cells is incomplete
  • Also thought once a cell becomes destroyed and DNA gets released that DNA is not completely cleared from body and immune system and recognizes it as foreign – makes antibodies against it
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20
Q

diagnosis of lupus

A

presence of LE cell
CRP levels - increased
complement levels - decreased

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21
Q

what is LE cell

A

neutrophil that has engulfed the antibody coded nucleus of another neutrophil

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22
Q

purpose of ANA test

A
  • Rule in and rule some diseases out
    • Rarely definitive just by testing alone: good place to start
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23
Q

cells used in ANA

A

hep 2 cells

  • Part of continuous cell line, we use these to look at mitotic cells
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24
Q

gold standard for lupus

A

Fluorescent

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25
homogenous
even pattern of staining -need to see mitotic cells -means antibodies to double stranded DNA or histone complex
26
high titers in homogenous =
lupus
27
low titers in homogenous
RA or drug induced lupus
28
what does homogenous pattern need to be followed up with
DNA test
29
what stains the brightest
peripheral -mitotic cells must also stain
30
what does peripheral stain mean
producing antibodies to double stranded DNA or histone complex
31
what does peripheral stain follow up with
DNA test
32
in speckled pattern
mitotic cells do not stain
33
speckled pattern should be followed up with
ENA- extrable nuclear Ag
34
speckled patterns are
non specific ex can be smith SS-A SS-B Scl-70
35
smith Ag
only antigen that is associated with lupus that causes speckled pattern
36
SS-A also called
ro
37
SS-B also called
La
38
SS-A and SS-B indicate
Sjogren's syndrome
39
scl-70 associated with
scleroderma
40
in nucleolar only
nuclei stain -NO mitotic cells stain
41
nucleolar is antibodies against
own RNA -seen in scleroderma or mixed connective tissue disease
42
centromere also called
starry night patten =46 speckles
43
in centromere antibodies against
centromeres
44
in centromere do mitotic cells stain
NO
45
centromere associated with
CREST- form of scleroderma -this pattern is definitive
46
classic test for DNA testing
Crithida lucilae organism : parasite to blowfish
47
what do we want stained in Crithida lucilae
kinetoplast -very rich in double stranded DNA
48
decrease in titer in DNA testing shows
medication is working
49
in drug induced lupus DNA test is
negative
50
steroid drugs that cause drug induced lupus
Isoniazid Procainamide
51
titer in what stain is seen for drug induced lupus
low homogenous titer
52
automated ANA
not as sensitive and specific as indirect fl. -Can tell specific pattern have to titer it out-- more distinguished
53
multiplex testing
- Detect multiple nuclear antigens using same specimen
54
antiphospholipid antibodies
- Antibodies against phospholipids : often seen in DVT and major source of miscarriages (later in pregnancy)
55
lupus patients produce what 2 antibodies
anticardiolipin lupus anti-coagulant
56
anti-cardiolipin
cause false + in RPR
57
lupus anti-coag
prolonged APTT and PT -not correct with mixing normal serum
58
lupus anti-coag in vivo
bind to clotting inhibitors
59
lupus anti-coag in vitro
bind to clotting factors
60
#1 cause of death od lupus patients
kidney failure
61
what is scleroderma
overproduction of collagen in tissue -hardening of the skin
62
symptoms of scleroderma
○ Raynaud's syndrome- antigen antibody complex on small blood vessel underneath the skin
63
another form of scleroderma
CREST -systemic sclerosis -milder form
64
sjogren's syndrome
dry eye and mouth syndrome
65
if sjogren gets systemic can involve
GI and pancreas function due to antibodies
66
what enhances severity and onset of RA
cigarette smoking
67
how to specify RA
can be organ specific or systemic
68
symptoms of RA
-morning stiffness - need movement -small joint to large joint swelling
69
presence of what interferons cause destruction in RA
IL-6 IL-17
70
RA is considered what kind of hypersensitivity
type 3
71
antibodies in RA
Anticyclic citrullinated peptide Ab (anti-CCP Rheumatoid factor
72
Anticyclic citrullinated peptide Ab (anti-CCP
-almost always found in RA -most specific for RA
73
what is rheumatoid factor
Typically IgM produce against altered Fc portion of an IgG particle -first antibody discovered
74
what antigen is found in RA
NHC-DRB1
75
what non specific test can be done for RA
cryoglobulins -IgM precipitate in the cold -put in fridge and look at bottom
76
False + on cryptococcus Ag test from
rheumatoid factor
77
treatment for RA
* Reduce inflammation --steroids * Methotrexate * Cytokine blocking drugs
78
age onset for multiple sclerosis
20-50 chronic women
79
is there 1 test to diagnosis MS
no must do lots of testing
80
what can enhance MS
environmental factors such as stress -some viruses may induce antibody inflammation
81
how does MS occur
Destruction of myelin sheath - antibody and cytokine mediated -increased IL-1 and tumor necrosis factor
82
increased production of what Ig in MS
IgG in csf >0.70= MS know formula
83
what antibody found only in CSF in MS
myelin basic protein
84
what band found in gamma region in MS
oligoclonal banding
85
Myasthenia Gravis affects
neuromuscular junction -can be seen with other autoimmune disease -increased risk of developing RA or lupus
86
2 onsets of Myasthenia Gravis
○ Early - develop symptoms in teens ○ Late - develop symptoms after 40
87
symptoms of Myasthenia Gravis
* Start in face and head; eye and mouth drooping on 1 side of the face * Affects vision, speech * Gets worse as more tired (end of the day)-- more severe * Gait * After menstrual cycle, cause infertility * Numbness in legs Weakness in upper limbs
88
antibody in Myasthenia Gravis
acetylcholine receptors
89
celiac disease affects
small intestine- essential for absorption -leads to malnutrition
90
culprit of celiac disease
gluten
91
what is used as confirmatory test for celiac test
HLA-DQ2 and HLA-DQ8
92
predisposing factors in celiac disease
european relatives with this IgA def type 1 diabetes
93
symptoms of celiac disease
* GI symptoms * Dermatitis herpetiformis - blistering skin condition
94
what is found in gluten
gliadin -gluten acted on by tissue transglutaminase no villi= no absoprtion
95
to truly diagnose celiac disease need
biopsy of small intestine
96
#1 test that used to be for celiac disease
Abs gliaden
97
tests now for celiac disease
Tissue transglutaminase Abs endomysial Abs
98
Tissue transglutaminase Abs
-most specific test -first IgA, if negative but sus do IgG
99
Endomysial Abs
Highly specific for celiac disease
100
autoimmune hepatitis
attacks liver have to rule out all other liver diseases
101
testing for autoimmune hepatitis what do u look for
ASMA-anti smooth muscle antibody ANA liver enzymes- increase ALT and AST
102
most common test done for autoimmune hep
ASMA -antibodies against microsome of liver and eventually kidney
103
ANA for autoimmune hep
looks homogenous but mitotic cells negative
104
most common autoimmune liver disease
Primary Biliary Cholangitis (Cirrhosis)
105
Primary Biliary Cholangitis (Cirrhosis) is antibodies against
bile duct inflammation of duct and blockages -conjugated bili does not get as high
106
symptoms of Primary Biliary Cholangitis (Cirrhosis)
dry eyes and mouth itching around the liver
107
antibody seen in Primary Biliary Cholangitis (Cirrhosis)
AMA- antimitochondrial antibodies
108
Granulomatosis with Polyangiitis/ Wegener's Granulomatous Disease
Form of vasculitis -- inflammation in small arteries and veins
109
main race that Granulomatosis with Polyangiitis affects
caucasian men and women equal
110
antibody in Granulomatosis with Polyangiiti
ANCA- anti-neutrophilic cytoplasmic Abs -against azurophilic granules
111
symptoms of anti-neutrophilic cytoplasmic Abs
* Start in respiratory tract, runny nose, sore throat, but can't understand * Can have bloody sputum * If not treated can lead to lose of vision, hearing, lots of tissues
112
antibodies in Granulomatosis with Polyangiitis
cytoplasmic antibodies perinuclear antibodies
113
Cytoplasmic antibodies connected to
PR3 antigen
114
Perinuclear antibodies connected to
myeloperoxidase antigen (MPO)

immuno (12 decks)

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