Immunology

Instructor: Dr. M. Wallace

1. Immunoglobulins

The human body produces five types of immunoglobulins:

  • IgG: Most abundant, found in all body fluids, crosses the placenta, responsible for secondary immune response.

  • IgA: Found in respiratory passages, tears, saliva, breast milk, colostrum.

  • IgM: Found in blood and lymph, first to fight infection, forms antibodies for blood antigens.

  • IgE: Associated with allergic reactions (bee sting), found in lungs and mucus membranes, fixes to mast cells and basophils, aids in defense against parasitic infections.

  • IgD: Least abundant, function not well understood.

Rheumatic Diseases

2. Rheumatic Diseases Overview

  • Encompass autoimmune, degenerative, inflammatory, and systemic conditions.

  • Affected Areas: Joints, muscles, soft tissues.

  • Over 100 Types of rheumatic diseases.

  • Problems Caused: Mobility limitations, pain, fatigue, altered self-image, systemic effects, organ failure.

3. Rheumatoid Arthritis (RA)

Definition

An autoimmune disease causing joint inflammation, affecting other organs (heart, lungs, blood vessels, etc.), leading to pain, swelling, and joint destruction. More common in women.

4. Pathophysiology of RA

  • Inflammation: Leads to pannus formation, cartilage erosion, joint destruction.

  • Autoimmunity: Immune system attacks self-tissues.

  • Degeneration: Secondary process resulting from inflammation.

5. Signs & Symptoms of RA

Early Symptoms:

  • Joint inflammation

  • Systemic: Low-grade fever, fatigue, weakness, anorexia, paresthesias

Late Symptoms:

  • Joint Deformities: Swan neck, ulnar deviation

  • Systemic Effects: Osteoporosis, severe fatigue, anemia, weight loss, subcutaneous nodules, vasculitis, pericarditis, Sjögren's syndrome, kidney disease

6. Diagnostic Testing for RA

  • Blood Tests: RF, anti-CCP, CBC, ESR, CRP, ANA

  • Imaging: MRI, PET scan, CT scan, Bone scan, DEXA scan

7. Drug Therapy for RA

  • NSAIDs: Reduce inflammation, relieve pain.

  • DMARDs: Methotrexate (preferred), sulfasalazine (slow disease progression).

  • JAK Inhibitors: Tofacitinib (Xeljanz), Baricitinib (alternative to DMARDs).

8. Nursing Management for RA

  • Pain Management: Medications, non-pharmacologic interventions (heat/cold therapy, relaxation).

  • Fatigue & Mobility Support: Energy conservation techniques, assistive devices, physical therapy.

  • Self-care & Body Image: ADL assistance, emotional support.

  • Complications from Medications: Monitor for side effects, educate on adherence.

Gout

9. Gout Overview

  • More common in men.

  • Risk factors: Age, BMI, alcohol, diuretics, hypertension.

  • Associated with increased cardiovascular disease risk.

10. Causes of Gout (Hyperuricemia)

  • Uric acid buildup from purine metabolism.

  • Urate crystals form in joints, causing pain and inflammation.

11. Types of Gout

Primary Gout

  • Inborn errors of purine metabolism → Excess uric acid → Sodium urate deposits in joints.

Secondary Gout

  • Caused by other conditions (renal disease, diuretics, cancer).

  • Treatment focuses on underlying disorder.

12. Stages of Gout

  1. Asymptomatic Hyperuricemia

  2. Acute Gouty Arthritis: First attack, extreme pain, podagra (big toe inflammation).

  3. Chronic/Tophaceous Gout: Urate crystal deposits in skin and organs (kidneys).

13. Diagnostic Tests for Gout

  • Uric acid levels

  • Synovial fluid aspiration

  • X-rays

14. Drug Therapy for Gout

  • Acute Attack: Colchicine, NSAIDs, Corticosteroids.

  • Chronic Management:

    • Xanthine Oxidase Inhibitors (Allopurinol, Febuxostat).

    • Uricosurics (Probenecid).

    • Pegloticase (IV therapy for severe cases).

15. Nursing Management for Gout

  • Joint Support: Elevation, ice packs, assistive devices.

  • Bed Rest & Protection: Limit movement, use bed cradle.

  • Dietary Adjustments: Low-purine diet, increased hydration, avoid alcohol.

  • Medication Compliance: Avoid stopping medications during flares.

Other Autoimmune Disorders

16. Lyme Disease

Cause:

  • Borrelia burgdorferi (tick-borne bacterial infection).

Stages & Symptoms

  1. Stage 1 (Early Localized):

    • Bull’s-eye rash, flu-like symptoms.

    • Treatment: Doxycycline, Amoxicillin (if pregnant).

  2. Stage 2 (Early Disseminated):

    • Neurological (facial palsy), cardiac issues (Lyme carditis).

    • Treatment: Oral antibiotics, IV Ceftriaxone (severe cases).

  3. Stage 3 (Late Lyme):

    • Chronic arthritis, neurological issues, memory problems.

    • Treatment: Long-term antibiotics.

Nursing Care

  • Antibiotic Therapy: Doxycycline (first-line), Amoxicillin.

  • Prevention: Insect repellent, protective clothing, proper tick removal.

17. Systemic Lupus Erythematosus (SLE)

  • Chronic autoimmune disease affecting multiple organs.

  • More common in women of color.

Symptoms

  • General: Fatigue, fever, weight loss.

  • Skin: Butterfly rash, photosensitivity.

  • Joints: Arthritis.

  • Renal: Lupus nephritis.

  • Cardiopulmonary: Pleuritis, pericarditis.

  • Neurological: Seizures, psychosis.

Treatment

  • NSAIDs, Corticosteroids, Hydroxychloroquine (antimalarial), Immunosuppressants (Methotrexate, Belimumab).

Diagnostics

  • ANA (Abnormal in 94% of cases), discoid rash, hematologic abnormalities.

Nursing Care

  • Monitor for organ damage, educate on sun protection, infection prevention.

18. Scleroderma

  • Localized (skin involvement only) vs. Systemic (multiple organ involvement).

CREST Syndrome (Limited Symptoms)

  • Calcinosis

  • Raynaud’s phenomenon

  • Esophageal dysfunction

  • Sclerodactyly

  • Telangiectasia

Medications

  • Calcium channel blockers, Angiotensin II blockers, Endothelin-receptor antagonists.

19. Fibromyalgia

  • Chronic condition causing widespread pain, fatigue, cognitive difficulties.

Treatment

  • Pain Management: Pregabalin, Duloxetine, Low-dose antidepressants.

  • Lifestyle Modifications: Exercise, limit caffeine/sugar, mental health support.

20. Organ Transplantation

  • Autograft (from self)

  • Allograft (from another human)

  • Isograft (from identical twin)

  • Xenograft (from another species)