Transcript AUTOIMMUNE DISEASES

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
Dendritic
cell
IL-6
• Autoantibody production
and self-perpetuation
TNF-
IL-10
Plasma cell
T cell
RF
TNF-
Macrophage
RF
RF
RF
RF
Fix complement
IL-1
IL-6
(Dörner & Burmester, 2003; Edwards et al, 1999; Gause & Berek, 2001; Shaw et al, 2003;
Takemura et al, 2001; Zhang & Bridges, 1986)
B cell
B cell
B cell
TNF-
IL-10
Inflamed synovia
Cartilage loss
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
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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
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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