Autoimmune

Autoimmune diseases
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Terms in this set (29)
Autoimmune diseases
-there are over 100
-13% of americans cannot name one
-75% has affected women (top 10 killer of women greater than 65)
-50 million americans have an autoimmune disorder
-they cluster in families
Autoimmune disorders
-see about 6 doctors before they are diagnosed
-take an average of 5 years before they are diagnosed
Gender differences
-men have a less vigorous immune response with less antibody production and a more susceptible to infection
-women have a more intense immune response to infections and have more success fighting off infections
-when challenged with a foreign antigen, women develop higher antibody levels (thus at greater risk for illnesses caused by an overactive immune response)
Rheumatoid Arthritis
-progressive inflammatory disease of connective tissues
-occurs when immune complexes attack the lining of various joints, causing pain, swelling, and stiffness
-can occur in the eyes, lungs, skin, and nervous system
-inflammation can damage bones, cartilage, and result in deformity and loss of movement
Diagnostics for RA
-positive rheumatoid factor in 80%
-increase in ANA
-anti CCP
Treatment for RA
-xrays for monitoring disease process
-hot and cold treatment and joint protection
Medications for RA
-DMARDs (slow or prevent joint destruction in first 3 months), biologic response modifiers (bind to TNF in inflammation), NSAIDS, analgesics, corticosteroids, omega 3 fatty acids (reduce swollen, painful joints and morning stiffness)
-curcumin has greatest improvement!
-cumin/tumeric are also good!
Lupus
-chronic, multisystem autoimmune disease that occurs worldwide and affects women 9x more than men
-female hormones, UV light, stress, and toxins play a role
Symptoms (11)
-PATIENT MUST HAVE AT LEAST 4 INCLUDING A POSITIVE TEST FOR ANTINUCLEAR ANTIBODIES
-macular rash (butterfly)
-discoid rash (raised patches)
-sensitivity to sunlight
-mouth sores
-arthritis
-serositis
-kidney dysfunction
-neurologic
-low WBC, RBC, platelet
-ANA
-immunologic (positive anti double stranded DNA test)
Lupus (SLE)
-characterized by remissions that can last for years or acute exacerbations
-can cause cardiac, pulmonary, renal involvement early in the disease
-atherosclerosis, infection, and nephritis are the major causes of death
Scleroderma-chronic, progressive autoimmune disease of the connective tissues that, when localized, involves skin and muscles -when systemic involves esophagus, GI tract, lungs, kidneys, heart, blood vessels, and internal organs -LAB: positive anticentromere antibodiesScleroderma symptoms-thickening and tightening of skin at the ends of fingers -Raynaud's -skin becomes tight and shiny (prevents facial expressions)CREST-calcinosis: painful deposits of calcium -raynauds: vasospasm of fingers and toes -esophageal dysfunction: food doesn't go down -sclerodactyly: tightening of skin -telangiectasia: red spots on hands, forearms, palms, face from capillary dilationScleroderma-dysmotility occurs throughout GI tract -can cause scar tissue in lungs resulting in SOB, chest pain, cough -scar tissue in heart causes heart failure and arrhythmiasMedications of scleroderma-Raynauds: antiHTN -joint pain/stiffness: NSAIDs, analgesics -etc.Sjogren's syndrome-systemic autoimmune disease characterized by lymphocytic infiltration of salivary and lacrimal glands leading to dry mouth (xerostomia) and dry eyes (keratoconjunctivitis sicca) as a consequence of progressive glandular destruction of dysfunction -dry eyes and dry mouth are "hallmark" (sicca syndrome)Facts-4 million americans affected -90% are women (postmenopausal) -10% men and children as young as 5 -44 times greater to develop Hodgkin'sPrimary and Secondary-primary SS is a previously healthy individual whom develops sicca syndrome -secondary SS is someone whom have a preexisting connective tissue problem and this is a further complicationWhy it is important-second most common autoimmune disorder, second to RA -major health problem that interferes with daily life -can lead to devastating problems and health issues -holds clues for autoimmunity and cancers (lymphomas)Etiology-disordered immunity -genetic susceptibility -hormonal influences -environmental influences -not a true cause or cureOral manifestations-frequent ingestion of fluids -avoid spicy acidic foods -sore or burning mouth -abnormalities of taste -difficulty chewing, swallowing dry foods, speaking, wearing dentures -loss of glistening of tongue and mucous membranes -dental caries -diminished salivary pool under tongue -salivary gland swelling -candidiasis, erythemia, and fissuring of tongue, angular cheilitisOcular manifestations-foreign body sensation -dry eyes, burning, itching -redness, eye fatigue, photosensitivity, blepharitis (eyelid infection)Severe dry eye can lead to-bacterial conjunctivitis -corneal ulcers -corneal perforation -loss of visionExtraglandular manifestations-general: fatigue, malaise -skin: xeroderma, vasculitis -ENT: epistaxis, sinus congestion/infection -pulmonary: xerotrachea, bronchitis -GI: GERD, decreased esophageal motility -neuro: peripheral sensory neuropathy -GYN: dyspareunia, vulvovaginitis -Heme: anemia, leukopeniaDiagnosis-rule out others -20% overshadow dryness -takes about 6.5-7 years to diagnose -Shirmer's test (less than or equal to 5 for 5 minutes is positive) -vital dye to see dry spots -fluorescein tear break up time (how long cornea remains covered with tear film) -salivary gland biopsy/flow rate/scintigraphyLab abnormalities-presence of anti-SSA/Ro and anti-SSB/La -positive ANA -positive RA -elevated ESR and CRPTreatment of dry eye-artificial tears, lacriserts, ocular ointment (can't see that well so use at night -tear preservation, avoid certain activities that make eyes dry -treat inflammation (restasis)Treatment of dry mouth-avoid alcohol/caffeine/smoking -dental hygiene -hydration with water -artificial saliva -oral/lip lubricant -sugarlesss gum and acupuncture -Salagen and Evoxac (increase saliva)Salagen and Evoxac-anticholinergics (muscarinic agonists) -patients still have acinar cells on salivary glands that respond to stimulation -increase secretion of exocrine glands -sweating is big side effect