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Autoimmune Disorders (Type 3 (Immune Complex) (Systemic Lupus…

- - - - S/S
        
        Joint pain
        
        Reddened skin rashes ('butterfly rash')
        
        Baldness
        
        Tx
        Monoclonal antibodies (-mab)
        
        Binds to CD20 on B cell surface --> down regulate B cell receptor & +apoptosis of CD20 cells
        
        Used for autoimmune diseases (eg: rheumatoid arthritis, myasthenia gravis)
        - Rituximab (Rituxan, IV) - Belimumab (Benlysta, IV)
  - - - S/S
        
        Joint pain
        
        Systemic
        
        Vasculitis
        
        Eye lesions
        
        Pleuritis, pericarditis
        
        Splenomegaly & lymph node enlargement
        
        Criteria for RA:
        
        Morning stiffness for at >1h for >6 wks
        
        Swelling of >3 joints for >6 wks
        
        Swelling of wrist, metacarpophalangeal/proximal interphalangeal joints for >6 wks
        
        Symmetrical joint swelling
        
        Rheumatoid nodules
        
        Serum RF
        
        Progressive Joint Destruction:
        
        May lead to subluxation (dislocation) --> misalignment of bone ends
        
        Joint instability
        
        Limited ROM
        
        Tx
        
        DMARDs (Disease Modifying Anti-Rheumatic Drugs)
        
        Antirheumatic drugs, grouped via use in RA, but otherwise pharmacologically unrelated
        
        All inhibit cell growth
        
        Common S/E: Renal toxicity (contraindication in renal failure)
        
        Hydroxychloroquine (anti-malarial)
        
        Methotrexate (anti-folate)
        
        Leflunomide (pyrimidine synthase inhibitor)
        
        Cyclosporine (calcineurin inhibitor)
        
        Azathioprine (purine synthase inhibitor)
        
        Cyclophosphamide (alkylating agent)
        
        Sulfasalazin (unknown mechanism)
        
        BRMs (Biological Response Modifiers)
        
        Substances that stimulate body's response to infection/disease
        
        Interferons, IL2, colony-stimulating factors (CSF, GM-CSF, G-CSF)
- - - - S/S
        
        General 'increased intensity' of everything (hyperthyroidism)
        
        Goiter
        
        Ophthalmopathy
        
        Tx
        
        Thioamides
        
        Mechanism of Action:
        Inhibits thyroid peroxide --> iodide --x--> iodine --x--> MIT/DIT --x--> T3/T4
        
        Well absorbed PO
        
        PPB 75-80%
        
        Propylthiouracil
        
        Methimazole
  - - - S/S
        
        Muscle weakness (starting at eyes --> proximal muscle)
        
        Weak chewing & swallowing muscles
        
        Remission & relapses
        
        Myasthenia crisis
        
        Tx
        
        Ach-esterase Inhibitor (-stigmine)
        
        Long-acting cholinesterase inhibitors
        
        Neostigmine (4h duration, PO)
        
        Pyridostigmine (8h duration, PO)
        
        Immunosuppressants
        
        Thymectomy
        
        Plasmapheresis (blood filtering to remove antibodies)
        
        IV immunoglobulins
- - - - Type 1A
        
        Type 1 = Loss of beta cell fx and/or absolute insulin deficiency
        
        Type 1A = Immune-mediated diabetes
        
        Any age
        
        Progressive inability of pancreas to make insulin d/t autoimmune destruction of beta cells
        
        Common in children with abrupt onset
        
        Latent Autoimmune Diabetes of the Adult (LADA) = slower adult Type 1 onset
        
        Etiology
        
        Genetic
        
        Environmental agent that triggers immune response [?]
        
        Immunologically mediated beta cell destruction
      - Type 1B
        
        Type 1B = Idiopathic diabetes
        
        No autoimmunity present
        
        Most are Asian/African descent
        
        Strongly inherited
      - Type 2 = Impaired tissue ability to use insulin and/or impaired release of insulin
  - - - Pathophysiology
        T cell-mediated autoimmune response to an unidentified antigen --> T helper cells make cytokines that stimulate abnormal growth of keratinocytes & dermal blood vessels --> hyperkeratosis
        
        Etiology
        
        Early peak: 16-22 yrs
        
        Later peak: 57-60 yrs
        
        Genetic
        
        Psoriatic Arthritis
        Inflammatory arthritis associated with psoriasis
        Peak: 30-55 yrs
        T lymphocytes and macrophages infiltrate skin & joints, making inflammatory cytokines
        
        S/S
        
        Papules and plaques
        
        Asymmetric oligoarthritis
        
        Soft tissue & peripheral joint disease with enthesitis and dactylitis
        
        Tx
        
        NSAIDs
        
        Corticosteroids
        
        Emollients
        
        Keratolytic agents
        
        Immunosuppressive therapy
- - - - - Interferon Alfa-2b (Intron A)
        
        Increases phagocytic activity of macrophages and monocytes
        
        Suppresses the growth of cancer cells
        
        Therapeutic uses:
        
        Cancers
        
        Chronic myelogenous leukemia
        
        Bladder cancer
        
        Multiple myeloma
        
        Renal cell cancer
        
        Viruses
        
        Herpes simplex virus
        
        HIV
        
        Varicella-zoster virus (VZW)
        
        West Nile virus
  - - - S/E
        
        Nephrotoxicity (-- urine flow)
        
        Hepatotoxicity (++liver enzymes)
        
        HTN
        
        Tremors
        
        Headaches
        
        Gingival hyperplasia
    - - - Basiliximab
        
        Indications
        
        Prophylaxis of kidney transplant rejection
        
        Mechanism
        
        Prevents binding of IL2 to CD25 on T cell surface
        
        S/E
        
        N/V, diarrhea, abdominal pain
        
        Anapylaxis
    - - Long-term S/E
        
        Osteoporosis
        
        Cataracts
        
        Mental status
        
        Fluid & sat retention
        
        HTN
        
        Hyperglycemia
        
        Obesity
        
        Adrenal atrophy