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