Comprehensive Study Notes on Autoimmune Diseases

Autoimmune Diseases Overview

  • Instructor: Jodi Steele

  • Year: 2024

  • COVID-19 Context

Gout

Definition

  • Gout is characterized as an inflammatory arthritis that typically affects the big toe.

  • It results from the accumulation of uric acid in the bloodstream.

  • Gout is not specifically classified as autoimmune.

Etiology

  • Elevated uric acid levels in the blood.

  • Diet high in purines contributes to uric acid production.

  • Increased intake of high-protein foods and alcohol raises uric acid levels.

  • Gout can be inherited or secondary to other conditions such as diabetes or poisoning.

Major Symptoms

  • Acute gout manifests through:

    • Redness of the affected area.

    • Heat and swelling.

    • Extreme pain.

    • Presence of fever.

  • Formation of sharp, needle-like urate crystals in tissues, leading to irritation.

  • Possible development of uric tophi that cause erosion of joint structures and mechanical issues.

  • Often associated with other medical conditions, such as hypertension.

Medications and Interventions

  • Common medications include:

    • NSAIDs (Non-Steroidal Anti-Inflammatory Drugs).

    • Analgesics for pain management.

    • Steroids to reduce inflammation.

    • Metabolic drugs aimed at reducing uric acid levels.

Massage Considerations

  • Contraindications (CIs):

    • Local massage is contraindicated during acute episodes of gout.

    • Systemic massage is contraindicated if fever or malaise is present.

    • Caution with permanent joint changes.

  • Ice is generally used for inflammation; however, in the case of gout, it could promote crystallization, potentially worsening the condition.

Treatment Approaches

  • Medical Treatment:

    • Focus on pain relief through medications, dietary modifications, and protecting joints.

    • Erosion of bones left untreated can lead to fractures.

  • Massage Techniques:

    • Avoid manipulation, traction, and pressure during acute phases; may worsen inflammation.

    • When gout is not acute and effectively managed, massage can be beneficial.

  • Heightened risks include kidney and cardiovascular problems associated with chronic gout.

Ankylosing Spondylitis

Definition

  • Ankylosing spondylitis involves inflammation and stiffness of the spinal joints that may progress to fusion of these joints.

Etiology

  • Occurs more frequently in men than women.

  • Often linked with the HLA-B27 genetic marker.

  • Autoimmune attacks begin at the sacroiliac (SI) joints and can progress upwards.

  • Cartilaginous discs may ossify over time.

  • Other areas that can be affected include heels, hips, shoulders, toes, and the sternoclavicular (SC) joints.

  • Classified as seronegative, indicating absence of antinuclear antibodies (ANA).

Major Symptoms

  • Symptoms include:

    • Flattening of the lumbar curve and exaggeration of the thoracic curve.

    • Reduced lung capacity.

    • Osteoporosis and nerve compressions.

    • Possible loss of bowel and bladder function.

    • Active symptoms can include pain, fever, and iritis.

    • Symptoms may exhibit a flare-remit pattern with some visceral manifestations.

Medications and Interventions

  • Typically prescribed medications include:

    • NSAIDs and analgesics for pain relief.

    • Corticosteroids to reduce inflammation.

    • Immune suppressant medications.

    • Surgical options may be considered in advanced cases.

Massage Considerations

  • Contraindications (CIs):

    • Local massage is contraindicated during acute flare-ups.

    • Systemic massage is contraindicated if fever or malaise is present.

    • Caution is advised if there are permanent joint changes.

  • Massage can be beneficial between flare-ups to maintain mobility and lung function.

Treatment Approaches

  • As a progressive inflammatory condition, massage is not recommended during flare-ups due to inflammation risk.

  • Light pressure is advised to avoid fractures, as patients are at risk.

  • Massage plays an essential role in managing pain, promoting functionality, and relaxation between flare-ups.

  • Positioning during treatment is crucial, especially if joints are fused.

Lupus

Definition

  • Lupus is an autoimmune disease that can attack various tissues, with manifestations ranging from mild to life-threatening.

Etiology

  • More prevalent in women than men, with a ratio of approximately 9:1.

  • Affects blood vessels and can present multiple symptoms through different body structures.

  • Causes are largely unknown, but predispositions include:

    • Genetic factors.

    • Hormonal influences, specifically elevated estrogen levels.

    • Environmental exposures to UV light, infections, certain medications, and mental health challenges.

    • Race/geography factors—particularly affecting Black women in the US and UK, but rare in Western/Central Africa.

  • The immune system indiscriminately attacks various tissues, typically presenting an ANA positive result.

  • Symptoms may trigger a flare-remit pattern often initiated by stressors.

Major Symptoms

  • Symptoms include:

    • Debilitating fatigue and cognitive disorders.

    • Alopecia (hair loss).

    • Characteristic rashes, such as the butterfly rash on the face.

    • Ulcers on mucosal membranes, arthritis, and varied organ issues.

    • Abnormal blood count across different measures.

  • Two significant classifications:

    • Discoid Lupus: characterized by chronic, scaly red patches on the skin.

    • Systemic Lupus Erythematosus: leading to more severe impacts including arthritis, renal failure, thrombosis, psychosis, seizures, cardiovascular disease, and pleurisy.

Medications and Interventions

  • Treatment includes:

    • NSAIDs, analgesics for pain control.

    • Corticosteroids to manage symptoms.

    • Immune suppressants.

    • Antimalarial drugs to address skin rashes.

Massage Considerations

  • Contraindications (CIs):

    • Caution with massage during acute phases; conservative treatment preferred.

    • Need to protect skin and organ integrity during intervention.

  • More vigorous massage is appropriate between flare-ups, provided it respects tolerance levels and potential organ issues.

Treatment Approaches

  • Focus on promoting remission through medication and enhancing the quality of life.

  • Monitor for avascular necrosis due to treatments.

  • Massage is deemed helpful for relaxation and alleviating joint pain.

  • Hand massage can be particularly beneficial.

  • Reminder: many medications may mask pain.__

Scleroderma

Definition

  • Scleroderma is an autoimmune condition characterized by attacks on the blood vessels leading to the production of excessive collagen by fibroblasts, predominantly affecting the skin.

Etiology

  • The immune system targets the lining of small blood vessels prompting fibroblasts to hyper-secrete collagen.

  • Resulting scar tissue accumulates in various tissues.

  • Causes remain largely unknown; potential predisposing factors include:

    • Chronic inflammation, presence of chimeric cells (containing genetic material from another individual, typically from previous pregnancies).

    • Exposure to certain chemicals and viral infections.

Typical Facial Symptoms

  • Initial symptoms represented by CREST:

    • C: Calcinosis - calcium deposits accumulate in the skin, notably on the hands.

    • R: Raynaud’s phenomenon - episodic restrictions in blood flow usually to fingers and toes.

    • E: Esophageal dysmotility - decreased movement of the esophagus leading to GI sluggishness.

    • S: Sclerodactyly - thickening and hardening of the fingers.

    • T: Telangiectasia - small, dilated blood vessels that present as skin discoloration and spider veins.

Major Symptoms

  • Symptoms can range from mild to severe and may manifest as:

    • Localized edema.

    • Increased risk of blood clots.

    • Development of pulmonary fibrosis and renal failure.

    • Potential heart failure.

    • Systemic type can progress to involve internal organs.

    • Joint involvement is also common, with severe cases being potentially fatal.

Medications and Interventions

  • Commonly utilized treatments:

    • Immune modifiers to suppress the immune response.

    • Steroids are often prescribed.

    • NSAIDs and analgesics for symptom relief.

    • Treatments directed at specific organ complications as they emerge.

Massage Considerations

  • Contraindications (CIs):

    • Exercise extreme caution with massage due to the risk of organ damage and blood vessel complications (e.g., clot risk).

    • Lymphatic massage and hand therapy are particularly beneficial.

    • Aim to restore parasympathetic balance without destabilizing the client.

  • Consider warmth in the treatment room and proper positioning during therapy.

Rheumatoid Arthritis

Definition

  • Rheumatoid arthritis is described as an autoimmune attack specifically targeting the synovial tissues, though it can also affect other tissues.

Etiology

  • More prevalent in women, occurring in a ratio of approximately 3:1 compared to men.

  • Characterized by the involvement of B and T cells, along with antibodies and proinflammatory chemicals during flare-ups.

  • Symptoms typically present in a flare/remit pattern.

Major Symptoms

  • Symptoms can vary significantly in severity:

    • Acute phase symptoms include fever, malaise, intense pain, and lack of appetite.

    • Long-term outcomes may lead to joint deformity, such as rheumatic nodules.

  • Affects various structures including:

    • Blood vessels, serous membranes, skin, eyes, lungs, liver, and heart.

  • Joint symptoms commonly occur bilaterally:

    • Hands and toes are most frequently affected, followed by ankles and wrists; less commonly involves the neck and knees.

  • Physical manifestations can include:

    • Heat, pain, redness, swelling, and loss of function at the joints.

    • Thickening of the synovial membrane, cartilage erosion, affecting tendons and ligaments.

  • Sjögren’s syndrome may occur, leading to pathologically dry eyes and mouth.

  • Different classifications of rheumatoid arthritis include:

    • Juvenile type affecting children.

    • Pauciarticular affecting fewer than five joints.

    • Polyarticular affecting five or more joints.

    • Still’s disease representing a systemic variant.

Treatment Approaches

  • Treatment options may include:

    • Employing disease-modifying anti-rheumatic drugs (DMARDs).

    • Joint replacement may be necessary in severe cases.

Massage Considerations

  • Massage is commonly recommended for post-surgical joint replacement rehabilitation.

  • Specific considerations include:

    • Performing lymphatic massage following joint replacements.

    • Calf massage may help reduce the risk of deep vein thrombosis (DVT).

  • It is important to remember the implications of limited range of motion (ROM) in client positioning during massage.Suggest Schemes:

Psoriasis

Definition

  • Psoriasis is identified as an autoimmune skin condition characterized by the presence of scaly plaques.

  • Skin cells regenerate every 3-4 days, compared to the normal cycle of 28-32 days.

Etiology

  • Combination of genetic anomalies and immune system dysfunction contribute to psoriasis development.

  • Conditions that can trigger T-cell activation in the epidermis include:

    • Stressors to the body, infections, medications, weather changes, hormones, and smoking.

  • Psoriasis typically exhibits a flare/remit pattern.

Major Symptoms

  • Often associated with metabolic syndrome and diabetes.

  • Symptoms typically manifest as:

    • Flaky, thickened patches of shiny skin with distinctly defined edges.

    • Commonly found on the torso, elbows, knees, scalp, palms, soles, and nails.

  • Approximately 10-30% of patients may develop psoriatic arthritis, which is treated similarly to rheumatoid arthritis.

Medications and Interventions

  • Treatment options include:

    • Calamine creams, steroids, and immune suppressants for managing symptoms.

    • NSAIDs and analgesics may also be utilized, particularly where arthritis is present.

DAS 28

  • Next Steps:

    • Engage with the DAS 28 measurement tool for application in lab settings.

Questions?

  • Open Q&A:

    • Encourage discussion and questions related to autoimmune diseases and the material covered above.