Post on 23-Jan-2016
description
transcript
DISORDERS OF DISORDERS OF IMMUNITY II: IMMUNITY II:
AUTOIMMUNE DISEASESAUTOIMMUNE DISEASES
R. HUGO MARTÍNEZ LOZANO, M.D.R. HUGO MARTÍNEZ LOZANO, M.D.
Aug-12-2009.Aug-12-2009.
LEARNING OBJECTIVESLEARNING OBJECTIVES K & U:K & U:- GENERAL FEATURES- GENERAL FEATURES- IMMUNOLOGIC TOLERANCE- IMMUNOLOGIC TOLERANCE- MECHANISMS OF AUTOIMMUNITY- MECHANISMS OF AUTOIMMUNITY- THE MOST IMPORTANT CHARCT. OF:THE MOST IMPORTANT CHARCT. OF: - LES- LES - RA- RA - SS- SS - SYSTEMIC SCLEROSIS- SYSTEMIC SCLEROSISRef: 223-239 & lecture’s informationRef: 223-239 & lecture’s information
GENERAL FEATURESGENERAL FEATURES
FRECUENCY:FRECUENCY: DISEASE VS NORMALITYDISEASE VS NORMALITY
(Pathologic vs physiologic autoimm.)(Pathologic vs physiologic autoimm.)
CRITERIA FOR DX OF CRITERIA FOR DX OF AUTOIMMUNE DISEASESAUTOIMMUNE DISEASES
AUTOIMMUNE REACTIONAUTOIMMUNE REACTION NOT SECONDARY TO TISSUE NOT SECONDARY TO TISSUE
DAMAGEDAMAGE NO OTHER CAUSENO OTHER CAUSE
IMMUNOLOGIC TOLERANCEIMMUNOLOGIC TOLERANCE
CENTRAL: DEATH OF SELF-R LYMPHCENTRAL: DEATH OF SELF-R LYMPH (APOPTOSIS)(APOPTOSIS) PERIPHERAL:PERIPHERAL: - ANERGY: NO COSTIMULATORS B7- ANERGY: NO COSTIMULATORS B7 INHIBITORY R CTLA-4INHIBITORY R CTLA-4 - SUPPRESSION BY REGULATORY T - SUPPRESSION BY REGULATORY T - CLONAL DEL. BY ACTIVATION OF - CLONAL DEL. BY ACTIVATION OF INDUCED CELL DEATH (FASL-FAS)INDUCED CELL DEATH (FASL-FAS)
MECHANISMS OF AUTOIMMUNE DIS. ROLES: - GENETICS - INFECTION/INFLAMMATION
MUTATIONS:-AIRE-CTLA-4-ETC.
ROLE OF INFECTIONS
ROLE OF INFECTIONS
C. EPITOPE EXPOSITION & SPREAD.
SLE: GENERAL FEATURESSLE: GENERAL FEATURES
INCIDENCE: 1:700INCIDENCE: 1:700 SEX: 9:1SEX: 9:1 ETHNIC GROUPETHNIC GROUP AGE:AGE:
CLINICAL CRITERIA:CLINICAL CRITERIA:(TABLE 6-8. p. 228)(TABLE 6-8. p. 228)
MALAR RASHMALAR RASH DISCOIDE RASHDISCOIDE RASH PHOTOSENSITIVITYPHOTOSENSITIVITY ORAL ULCERSORAL ULCERS ARTHRITISARTHRITIS SEROSITISSEROSITIS RENAL INVOLVEMENTRENAL INVOLVEMENT ANAANA ETC.ETC.
ANAANA
GENERICGENERIC ANTI-DOBLE-STRANDED DNAANTI-DOBLE-STRANDED DNA ANTI-SMITH (Sm)ANTI-SMITH (Sm) ANTIHISTONE (DRUG-INDUCED LE)ANTIHISTONE (DRUG-INDUCED LE) SS-A & B (RNP)SS-A & B (RNP) ANTICENTROMERE (CREST)ANTICENTROMERE (CREST)
RISK FACTORSRISK FACTORS
GENETICGENETIC ENVIRONMENTALENVIRONMENTAL IMMUNOLOGICIMMUNOLOGIC
PATHOGENESIS:VASCULITIS(PHASES)
Lupus erythematosus: skin.
SKIN: ANTI-B.M. INJURY
Idem.
IDEM: (IMMUNEFLUORESCENCE)
Malar rash