autoimmune diseases
Post on 09-Jan-2016
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AUTOIMMUNE DISEASES
DR IDA DZIFA KUWORNOO
PHYSICIAN SPECIALIST
KBTH
• Greek word ‘auto’ meaning self.
• Due to failure of an organism to recognize its own constituent parts as self leading to an immune response against its own cells and tissues.
• Body’s own immune system begins to attack normal tissues cells and organs within the body.
Potential Roles of B Cells in the Immunopathogenesis of RA
• Secretion of proinflammatory
cytokines
• Antigen presentation
• T-cell activation
• Autoantibody productionand self-perpetuation
(Dörner & Burmester, 2003; Edwards et al, 1999; Gause & Berek, 2001; Shaw et al, 2003; Takemura et al, 2001; Zhang & Bridges, 1986) Cartilage lossCartilage loss
IL-6
B cell
T cell
Macrophage
Dendritic cell
IL-10TNF-
TNF-IL-10
RF
Fix Fix complementcomplement
Inflamed Inflamed synoviasynovia
Inflammatory Inflammatory damagedamage
TNF-
B cell
IL-6
B cell
Plasma cell
RF RF
RF
RF
IL-1
Predisposing factors
• Genetics eg.HLADR2-SLE and M. Sclerosis
• HLADR3 SLE, Sjogrens, Myasthenia ,DM type 1
• HLADR4 R. Arthritis, Pemphigus vulgaris
• Environmental
• Sex :They tend to have female preponderance 75%.
• Usually pubertal or childbearing age group
• Hormonal
• Infections :Bacterial or viral e.g. Klebsiella pneumoniae, Chlamydia, Coxsackie virus B.
• Parasitic infections may be protective
• Drugs
• Toxins ,pesticides.
Classification • Local eg Diabetes mellitus type 1,Graves
disease, Addisons disease
• Systemic eg. SLE, Rheumatoid arthritis, polymyositis etc
• GIT:e.g Crohns ,PBC,Autoimmune hepatitis• ENDOCRINE:e.g Type 1 diabetes,Graves
disease,Hashimotos thyroiditis• SKIN e.g.pemphigus vulgaris• NERVOUS SYSTEM e.g.multiple sclerosis,CIDP• HAEMATOLOGIC e.g.autoimmune hemolytic
anaemias,pernicious anaemia• RESPIRATORY e.g.COPD ,sarcoidosis
Symptoms and signs
• Malaise • Fatigue • Rashes • Hair loss• Febrile illness • Recurrent miscarriages • Visual impairment• Joint swellings or pain
• Memory loss
• Limb weakness
• Strokes
DIAGNOSIS
• Accurate history of the illness
• Physical examination
• High index of suspicion
LABORATORY TESTS
• Varied probable depends on system involved.
• Blood counts ,kidney function tests etc
Serological assays for diagnosis, expensive
• MRI’S
• Biopsies for local involvement
Treatment Non medical
• Multidisciplinary
• Counselors
• Physiotherapists
• Occupational therapists
Treatment
• Non immune therapy e.g. hormone replacement in thyroid disease, type 1 diabetes
• Immune modulatory drugs e.g. Steroids, TNF inhibitors etc.
• Anti inflammatory e.g. NSAIDS
• Palliative
• Together fourth largest cause of death among women.
• Affects more people than heart disease in the USA
• Poorly understood poorly recognised
• Need for more awareness
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