PRE-UNIT STUDY TIPS

• Make sure to understand what autoimmune diseases are.
• Many immune disorders are idiopathic; in this case, focus on memorizing risk factors and typical symptoms.
• Use examples to remember Type I, II, III, and IV hypersensitivity reactions and the functions of different immunoglobulins.

1. Autoimmunity

• The lack of response to the body’s own cells is known as tolerance

• autoimmunity occurs when individuals develop antibodies called autoantibodies to their own tissues or self antigens

  1.1 Lupus

  • chronic, affect skin, joints, heart, lungs, blood, kidneys, brain
  • risk factor: 90% woman, 15~44
  • types: systematic, cutaneous, drug-induced, neonatal
  • systematic lupus erythematosus (SLE):
    • 70%
    • 1/2 SLE develop severe heart lungs kidneys brain diseases
    • signs & symptoms: fatigue, arthritis, fever, butterfly rash across cheeks and nose, photosensitivity, mouth or nose ulcers, fingers turn white/blue when cold (Secondary Raynaud’s phenomenon)
  • Cutaneous or discoid lupus:
    • 10%
    • only affect skin
    • signs & symptoms: discoid rash: raised, scaly, red rash, but not itchy, circular; butterfly rash across cheeks and nose; rash on face neck scalp mouth nose vagina
    • 10% of cutaneous lupus will develop SLE
  • drug-induced lupus erythematosus (DILE):
    • 10%
    • 70+ prescription drugs: hydralazine (for high blood pressure), procainamide and quinidine (for irregular heart rythm), certain drugs entail a high risk
    • signs & symptoms: similar to SLE, but rarely affects organs, will disappear within days to months after discontinuing
  • Neonatal Lupus:
    • acquired from maternal autoantibodies, affect skin heart blood
    • signs & symptoms: rash within several weeks of life, persists about 6 months
    • etiology: idiopathic, environmental (infections, sulfa antibiotics, penicillin, UV, stress, certain drugs, hormones(ss grow severe before menstrual periods or during pregnancy, estrogen may)) and genetic may
  • diagnosis:
    • no testing will confirm
    • CBC, urinalysis, autoantibody testing, general level of inflammation, biopsy
  • characters:
    • chronic, relapsing, often with symptom-free remissions that can last for years
    • incurable, challenging management
    • most patients live a normal lifespan
  • patient care:
    • limit exposure to sunlight, tobacco, stress and fatigue
    • health diet, exercise, take care of fevers over 100 (37.8)
  • treatment:
    • for control
    • NSAIDs, corticosteroids, antimalarial medications, immunosuppressive drugs, monoclonal antibodies to inhibit autoantibody and antibody production

  1.2 Scleroderma

  • chronic disease of connective tissue
  • risk: women, 40s

  

  • localized form (LSc): affects only the skin
    • signs & symptoms: waxy patches (morphea) or streaks on the skin
    • tends to regress or stop progressing without treatment
    • normal lifespan
  • systemic form (SSc): involves internal organs and the skin
    • limited cutaneous SSc (lcSSc)
      • skin tightening confined to fingers, hands, arms below the elbows; may involve feet and legs below the knees
      • 10yr survival rate: 71%
    • diffuse cutaneous SSc (dcSSc)
      • skin tightening lcSSc+trunk, above the elbows, on the knees
      • 10yr survival rate: 21%
    • both affect internal organs, but dcSSc are at a greater risk for significant organ dysfunction
  • common initial ss: secondary raynaud’s, thickening & tightening of the skin of the fingers, pain in 2+ joints
  • early symptoms: heartburn, difficulty swallowing, shortness of breath
  • etiology: idiopathic
    • immune: stimulate fibroblasts to produce too much collagen
    • environmental & genetic: exposure to viral infections & chemicals to who are genetically predisposed
    • hormonal: women 4x (estrogen)
  • diagnosis:
    • history, physical exam
    • autoantibody testing and biopsy
  • treatment: no cure
    • no tobacco, bo cold & stress
    • exercise
    • small frequent meals
    • moisture skin
    • cannot be prevented
    • control: anti-inflammatory drugs, immunosuppressive drugs, vasodilators to treat raynaud’s

  1.3 Sjogren’s Syndrome

  • chronic, slow progressive, affects the exocrine glands
  • risk factor: 90% women
  • primary Sjogren’s syndrome
  • secondary Sjogren’s syndrome: occur along with rheumatoid arthritis, lupus, scleroderma
  • signs & symptoms:
    • dry eyes and mouth
    • complications in kidneys, gastrointestinal system, blood vessels, lungs, liver, pancreas, and CNS
  • etiology: idiopathic
    • environmental: viral infections
    • genetic: first-degree relative with autoimmunity disease
    • hormone: women during childbearing years
  • diagnosis:
  • treatment:

2. Allergy

• extreme immune response to a harmless antigen
• common allergensL ragweed or pollen, mold, bee venom, poison ivy, latex

3. Immune Deficiency

3.1 HIV infection

• primary HIV infection stage:
• clinically asymptomatic stage:
• symptomatic HIV stage:
• progression from HIV to AIDS
• HIV: a retrovirus that carries its genetic information as RNA rather than DNA