Autoimmune disorders and immunity

1. Autoimmune Disorders
Introduction:
Poul Ehelich realized that the immune system instead of reacting
against foreign antigens, could focus its attack on self-antigens. He
termed this condition horror autotoxicus. The mechanisms of self-
tolerance normally protect an individual from potentially self-reactive
lymphocytes, there are failures. This resulted in inappropriate response.
Autoimmunity:
Inappropriate response of the immune system against self-components is
termed as autoimmunity.
HISTORY:
In the 1960s, it was believed that all self-reactive lymphocytes were
eliminated during their development in the bone marrow and thymus and
that a failure to eliminate these lymphocytes led to autoimmune
consequences. Since the late 1970s ,experimental evidence revealing
that not all self-reactive lymphocytes are deleted during T-cell and B-
cell maturation. Instead, normal healthy individuals have been shown to
possess mature, recirculating, self-reactive lymphocytes. . The presence
of these self-reactive lymphocytes in the periphery does not result in
autoimmune reactions, their activity must be regulated in normal
individuals through clonal anergy .A breakdown in this regulation can
lead to activation of self-reactive clones of T or B cells, generating
humoral or cell-mediated responses against selfantigens. These reactions
can cause serious damage to cells and organs,sometimes with fatal
consequences.
(AARDA)

2. According to the American Autommunity Related Disease Association
(AARDA) an autoimmune disease develops when our immune system,
which defends our body against disease decide our healthy cells are
forigen ,as a result immune system attacks healthy cells.
Autoimmune diseases often run in families, 75% are women are
effected.4th largest disease class in females. African Americans,
Hispanics, and Native Americans also have an increased risk of
developing an autoimmune disease.
Classification of autoimmune disease:
Human autoimmune diseases can be divided into
1: Organ specific
2: Systemic diseases.
Organ specific:
The organ-specific diseases involve an autoimmune response directed
primarily against a single organ or gland. The autoimmune responses are
directed against antigens present only in a particular organ,
overstimulation of the cell or suppression of the normal functioning of
the cells.
eg. Autoimmune Hemolytic Anemia, Pernicious Anemia etc
Systemic diseases:
The systemic diseases are directed against a broad spectrum of tissues
and have manifestations in a variety of organs resulting from cell-
mediated responses and cellular damage caused by auto-antibodies (an

3. antibody produced by an organism in response to a constituent of its
own tissues) or immune complexes.
eg. Systemic Lupus Erythematous, Arthritis
Systematic lupus erythmatosus:
Introduction
Systemic lupus erythematosus (SLE) is the prototypic multisystem autoimmune
disorder with a broad spectrum of clinical presentations encompassing almost all
organs and tissues. The extreme heterogeneity of the disease has led some
investigators to propose that SLE represents a syndrome rather than a single
disease.
History of lupus:
Th e term ‘lupus’ (Latin for ‘wolf’) was first used during the Middle Ages to
describe erosive skin lesions evocative of a ‘wolf’s bite’. In 1846 the Viennese
physician Ferdinand von Hebra (1816–1880) introduced the butterfl y metaphor to
describe the malar rash. He also used the term ‘lupus erthymatosus’ and published
the first illustrations in his Atlas of Skin Diseases in 1856.
Symptoms of lupus:
• SLE is characterized by
• fever.
• weakness.
• Arthritis.
• skin rashes.
• pleurisy.( an inflammation of the pleura, which is the moist double-layered
membrane that surrounds the lungs)

4. • and kidney dysfunction
Causes of lupus:
1- Is is not linked to a certain gene.
2- Ultraviolet rays.
3- Certain medications.
4- A virus, physical or emotional stress, and trauma.
Mechanism:-
• Affected individuals may produce autoantibodies to a vast array of tissue
antigens, such as DNA.When immune complexes of auto-antibodies are
deposited along the walls of small blood vessels. The hypersensitive reaction
develops.The complexes activate the complement system.
• And damage the wall of the blood vessel.Excessive complement activation
in patients with severe SLE produces elevated serum levels of the
complement split products C3a and C5a.This lead to tissue damage.
Diagnosis:
• blood tests, such as antibody tests
• a complete blood count
• chest X-ray
Treatment:
Treatment for SLE is not curative. But Treatments may include:
1.anti-inflammatory medications for joint pain.
2 .steroid creams for rashes
3.corticosteroids of varying doses to minimize the immune response

5. Rheumatoid Arthritis
Arthritis means inflammation in a joint. That inflammation causes
redness, warmth, swelling, and pain within the joint.
Rheumatoid affects joints on both sides of the body, such as both hands,
both wrists, or both knees. This symmetry helps to set it apart from other
types of arthritis. RA can also affect the skin, eyes, lungs, heart, blood,
or nerves.
Overview
Many individuals with rheumatoid arthritis produce a group of auto-
antibodies called rheumatoid factors that are reactive with determinants
in the Fc region of IgG. The classic rheumatoid factor is an IgM
antibody with that reactivity. Such auto-antibodies bind to normal
circulating IgG, forming IgM- IgG complexes that are deposited in the
joints. These immune complexes can activate the complement cascade,
resulting in a type III hypersensitive reaction, which leads to chronic
inflammation of the joints.
The immune system produces antibodies that attach to the linings of
joints. Immune system cells then attack the joints, causing inflammation,
swelling, and pain. If untreated, rheumatoid arthritis causes gradually
causes permanent joint damage. Treatments for rheumatoid arthritis can
include various oral or injectable medications that reduce immune
system over activity.
What Are the Symptoms?
The warning signs of RA are:
 Joint pain and swelling
 Stiffness, especially in the morning or after you sit for a long time

6.  Fatigue
Rheumatoid arthritis affects everyone differently. For some, joint
symptoms develop gradually over several years. In others, it may come
on quickly. Some people may have rheumatoid arthritis for a short time
and then go into remission, which means they don’t have symptoms.
Who Gets Rheumatoid Arthritis: Anyone can get RA. It affects about
1% of Americans.The disease is two to three times more common in
women than in men, but men tend to have more severe symptoms.It
usually starts in middle age. But young children and the elderly also can
get it.
What Causes It?
Doctors don’t know the exact cause. Something seems to trigger the
immune system to attack the joints and sometimes other organs. Some
experts think that a virus or bacteria may change the immune system,
causing it to attack the joints. Other theories suggest that in some people,
smoking may lead to rheumatoid arthritis.Certain genetic patterns may
make some people more likely to get RA than others.
How Does It Affect the Body?
Immune system cells move from the blood into the joints and joint-
lining tissue, called synovium. Once they arrive, those immune system
cells create inflammation that leads to irritation, which wears down
cartilage (the cushioning material at the end of bones). As the cartilage
wears down, the space between the bones narrows. As it gets worse, the
bones could rub against each other. Inflammation of the joint lining

7. causes swelling and makes fluid build up within the joint. As the lining
expands, it can damage the bone.All of these things cause the joint to
become very painful, swollen, and warm to the touch.
Treatment:
Drugs:
(NSAID). nonsteroidal anti-inflammatory drug. These medications
reduce pain and inflammation but do not slow down RA.
“DMARDs” stands for disease-modifying antirheumatic drugs. They
help slow or stop RA from getting worse
Surgery for Rheumatoid Arthritis
Physical and Occupational Therapy
Graves disease
Thyroid gland: A gland that makes and stores hormones that help
regulate the heart rate, blood pressure, body temperature, and the rate at
which food is converted into energy. Thyroid hormones are essential for
the function of every cell in the body. They help regulate growth and the
rate of chemical reactions (metabolism) in the body. Thyroid hormones
also help children grow and develop.
Graves disease is an autoimmune disorder that leads to overactivity of
the thyroid gland (hyperthyroidism). An autoimmune disorder is a
condition that occurs when the immune system mistakenly attacks
healthy tissue.
What Is Graves' Disease?

8. First described by Sir Robert Graves in the early 19th century, Grave's
disease is one of the most common of all thyroid problems.It is also the
leading cause of hyperthyroidism a condition in which the thyroid gland
produces excessive hormones. Once the disorder has been correctly
diagnosed it is quite easy to treat. In some cases Graves' disease goes
into remission or disappears completely after several months or years. If
left untreated it can lead to serious complications -- even death.
What Causes Graves' Disease?
Hormones secreted by the thyroid gland control metabolism or the speed
at which the body converts food into energy.metabolism is directly
linked to the amount of hormones that circulate in the bloodstream. If for
some reason the thyroid gland secretes an overabundance of these
hormones, the body's metabolism goes into high gear, producing the
pounding heart , sweating,trembling, and weight loss typically
experienced by hyperthyroid people. Normally, the thyroid gets its
production orders through another chemical called thyroid-stimulating
hormone (TSH), released by the pituitary gland in the brain But in
Graves' disease, a malfunction in the body's immune system releases
abnormal antibodies that mimic TSH. Spurred by these false signals to
produce, the thyroid's hormone factories work overtime and exceed their
normal quota.
Is Graves disease a genetic disorder?
Graves' disease is not inherited However it has been seen to affect
members of the same family. An identical twin is more likely to have
Graves' disease the other twin is affected. Although there is a tendency
for autoimmunity to be inherited, a mother cannot 'pass on' an overactive
thyroid to her child.

9. Abstract :
Autoimmunity is the Inappropriate response of the immune system
against self-components is termed as autoimmunity
Human autoimmune diseases can be divided into
1: Organ specific
2: Systemic diseases.
Systematic lupus erythmatosus:
Systemic lupus erythematosus (SLE) is the prototypic multisystem
autoimmune disorder with a broad spectrum of clinical presentations
encompassing almost all organs and tissues. The extreme heterogeneity
of the disease has led some investigators to propose that SLE represents
a syndrome rather than a single disease.
Rheomatoid Arthritis
Arthritis means inflammation in a joint. That inflammation causes
redness, warmth, swelling, and pain within the joint.
Rheumatoid affects joints on both sides of the body, such as both hands,
both wrists, or both knees. This symmetry helps to set it apart from other
types of arthritis. RA can also affect the skin, eyes, lungs, heart, blood,
or nerves.
References:-
 Chapter 20 Systemic Lupus Erythematosus: Pathogenesis and
Clinical Features
 By George Bertsias, Ricard Cervera, Dimitrios T Boumpas
 Kuby immunology chapter 20 page no 467