Clinical Context of Immunology Flashcards
(25 cards)
What are 4 clinical features of Graves disease?
- Heart Palapatations
- Excessive sweating
- Weight loss
- Muscle Weakness
- Exophthalmos
- Increased in BMR
What is the type of Hypersensitivity in Graves’ Disease?
- Type 2 hypersensitivity.
- IgG antibodies against TSH receptor which mimic the hormone by stimulating the thyroid gland to produce thyroid hormones
What are the treatments available for Graves’ Disease?
Anti-thyroid drugs – Carbimazole
Radioactive iodine – to destroy thyroid cells
Surgery (thyroidectomy or sub-total thyroidectomy
What is the risk to the newborn of a woman with Graves’ Disease?
TSI can cross the placenta and act on the thyroid gland on the baby causing symptoms within the new-born. Can cause neonatal Graves’ disease
What are the features of Hashimoto’s Disease?
- Weight Gain
- Lethargy
- Cold intolerance
- Bradycardia
- Dry skin
- Hoarse Voice
- Constipation
- Slow reflexes
What are 2 autoantibodies in Hashimoto’s Disease?
- Anti-thyroglobulin antibody
* Anti-thyroid peroxidase antibody
What is a thyroid biopsy likely to show in Hashimoto’s Disease?
- Infiltrate of lymphocytes (CD4+ and CD8+)
- Plasma cells (with is a mature B cell producing a single antibody).
What is the treatment for Hypothyroidism and how is it monitored?
-Replacement therapy with Thyroxine
-Monitor clinically
TSH levels should return to normal and can be monitored
What is the main auto antibody found in blood test for Rheumatoid Arthritis?
-Autoantibodies to the Fc portion of immunoglobulin G (rheumatoid factor)
What other autoantibodies can occur in RA?
- Anti-Cyclic Citrullinated Peptide (anti-CCP). Also referred to as Anti-citrullinated protein antibody (ACPA)
- Antinuclear Antibodies
What are the main findings in relation to joint in Rheumatoid Arthritis?
- Chronic Symmetrical Polyarthritis
- Synovitis
- Joint destruction
What is the pathophysiology of the changes to joints found in RA?
- There is persistent synovitis, causing chronic symmetrical polyarthritis with systemic inflammation.
- There is over-activation of the inflammatory process. Chemoattractant produced in the joint recruit circulating inflammatory cells
- Over-production of tumour necrosis factor (TNF) leads to synovitis and joint destruction. Interaction of macrophages and T and B lymphocytes drives this over-production.
What can occur in lungs of patient with RA?
Nodules
What are other non0articular manifestations of RA
- Pericarditis
- Anaemia
- Leg ulcers
What is the treatment for Rheumatoid Arthritis?
DMARDs
- Sulfasalazine
- Methotrexate
- Hydroxychloroquine
- Leflunomide
Steroids
- Prednisolone
- Methylprednisolone
What is the type of hypersensitivity reaction in Systemic Lupus Erythematosus?
-Mainly Type 3
What is the pathophysiology of SLE?
- When cells die by apoptosis, the cellular remnants appear on the cell surface as small blebs that carry self antigens.
- These antigens include nuclear constituents (e.g. DNA and histones), which are normally hidden from the immune system.
- In people with SLE, removal of these blebs by phagocytes is inefficient, so that they are transferred to lymphoid tissues, where they can be taken up by antigen-presenting cells.
- The self antigens from these blebs can then be presented to T cells, which in turn stimulate B cells to produce autoantibodies directed against these antigens.
What are the immunological consequences of SLE?
The combination of availability of self-antigens and failure of the immune system to inactivate B cells and T cells that recognize these self-antigens (i.e. a breakdown of tolerance) leads to the following immunological consequences.
- Development of autoantibodies that either form circulating complexes or deposit by binding directly to tissues.
- Activation of complement and influx of neutrophils, causing inflammation in those tissues.
- Abnormal cytokine production
What are the main auto-antibodies to SLE?
-Antinuclear antibodies
This includes: Anti DNA (or anti double stranded DNA).
What other autoantibodies can occur in SLE?
- Anti-Sm antibodies
- Antiphospholipid antibodies
- Complements
What are 3 features of SLE?
- Butterfly rash on face
- Photosensitivity
- Urticaria
- Vasculitis
- Purpura
What might you find in a full blood counts of a patient with SLE?
- Anaemia
- Low white cell count
- Low platelet count
If there is evidence of haemolytic anaemia what test of the blood might help to confirm the autoimmune nature of the anaemia?
Blood Test: Coombs’ Test
What are 3 other body organs/systems that can be affected in SLE?
- Pericarditis
- Abdominal pain
- Renal disease
- Myositis
