Rheumatology, Immunology,

Three lines of defense

1st line - non-specific external barriers (skin, mucous membranes), 2nd line - leukocytes, macrophages, and inflammation; 3rd line - specific immune response.

Innate immunity

Non-specific defense mechanism that responds quickly and does not have memory.

Adaptive immunity

Specific immune response that varies from person to person, includes memory and longer response time.

Humoral immunity. What type of cells

Antibody-mediated immunity that utilizes antibodies to tag pathogens for destruction. Utilize B cells

Cell-mediated immunity. What type of cells?

Type of immunity involving T cells that directly attack infected or abnormal cells. Use T cells

Antibodies

Proteins produced by B cells that specifically bind to antigens.

Natural active immunity

Immunity resulting from exposure to an antigen that stimulates the production of antibodies.

Artificial active immunity

Immunity acquired through vaccination, leading to the production of antibodies.

Natural passive immunity

Temporary immunity acquired by receiving antibodies from another person, such as from mother to fetus via the placenta.

Artificial passive immunity

Temporary immunity gained by receiving injections of antibodies from another individual or animal.

Cytokines

Molecules that send signals to other immune cells to activate or regulate immune responses. Directors of the immune response

Complement system

A group of over 30 proteins that enhance both the innate and adaptive immune response.

IgA

An antibody class that prevents pathogens from adhering to mucosal surfaces.Passive immunity to new borns

IgD, what type of cells

A transmembrane protein that functions in B cell activation by antigens.

IgE

An antibody involved in allergic reactions and response to parasitic infections. Basophills

IgG

The most abundant antibody in blood, important for secondary immune responses.

IgM

An antibody that forms part of the receptor for B cells and is present at low levels in plasma.

Rheumatoid arthritis (RA)

An autoimmune disorder characterized by inflammation of the joints, resulting in pain and disability.

RA work up

Rhumatoid factor/antibodies. IGG antibodies, Anti CCP antibodies

What joint does RA not effect

Sacroiliac joint

Other manifesations of RA not joint

ILD, lung nodules, pericarditis, and antichilanerigic effects

RA treatments

Low dose steroids to bridge to DMARDs. Taper

Low dose NSAIDS

DMARDs- Methotrexate, Sulfasalazine, lefluomide

Antinuclear antibodies (ANA). What conditions

Autoantibodies directed against components of the cell nucleus, used as a diagnostic tool. Lupus, scleroderma, Antiphospholipid syndrome

Cytokine storm

An excessive inflammatory response that can be damaging to tissues and organs.

Memory B cell

Long-lived immune cells that can respond quickly upon re-exposure to the same antigen.

Memory T cell

Cells that allow for a rapid response to previously encountered antigens.

SLE (Systemic Lupus Erythematosus)

An autoimmune disease characterized by the production of a variety of autoantibodies and systemic inflammation.

SLE S/S and manifestations

Butterfly rash, Anemia, leukopenia, thrombocytopenia, glomerulonephritis, joint symptoms, photophobia

Lupus labs

ANAand anti-dsDNA, complemented by other specific autoantibodies.

Drug induced lupus vs normal. What drugs

ANA + but antibodies not. Hydral isoniazid, minocycline

Lupus treatment

Burst dose steroids, methylpred, hydroxyclorquine, anitbodiestargeted therapies, and immunosuppressants.

Antiphospholipid syndrome. Defintions and s/s

Hypercoagubility, thrombosis, platelet wasting. ANA+

AMS, vasculitis, thrombotic event, miscarriage, skin molting

Antiphosplipid syndrome treatment

Wasfarin, ASA, steroids

Raynaud phenomenon treatmen t

Calcium channel blockers

Scleroderma. What is it, treatments

Cutaneous thickening, with progressions to visceral thickening

ANA+

Supportive care, biologics

A 25-year-old woman presents with malar rash, photosensitivity, and proteinuria. Which of the following autoantibodies is most specific for a diagnosis of Systemic Lupus Erythematosus (SLE)

Anti-double stranded DNA (dsDNA)

Which of the following clinical features is most suggestive of Behçet’s Disease? 

Oral gentile ulcers and uvitis

5. A patient with hyperextensible skin, joint hypermobility, and a history of spontaneous arterial rupture likely has which type of Ehlers-Danlos Syndrome (EDS)?

Vascular EDS

Vasculitis

Inflammation of blood vessels that can lead to ischemic damage to tissues.

Polymyalgia Rheumatica, labs/def

An inflammatory disorder characterized by pain and stiffness in the shoulders and hips. Elevated ESR/CRP, anemia

Giant cell arteritis, lebs /def

A type of vasculitis that can cause headaches, jaw pain/claudication, and vision problems, primarily affecting older adults. Elevated ESR/CRP

Takayasu arteritis

A rare vasculitis affecting large blood vessels, especially in women of Asian descent. Effects aorta and branches

Polyarteritis nodosa. What is this a complication of? Anca?

A systemic vasculitis that primarily affects medium-sized muscular arteries.Pouching of vessels. Complications of HBV

ANCA negative

Granulomatosis with polyangiitis (Wegener's). Anca?

A small vessel vasculitis associated with upper AND lower respiratory tract disease and glomerulonephritis. Uvitis common.

Formation of granulomas

ANCA +

Eosinophilic Granulomatosis with Polyangiitis (Churg-Strauss)

A condition characterized by asthma, sinusitis, and eosinophilia associated with vasculitis.

Eosinophils

A type of white blood cell involved in the response to allergens and parasitic infections.