AutoimmunityQuiz

Emily Matthews (e.k.matthews@warwick.ac.uk)

Chris Lancaster (c.j.lancaster@warwick.ac.uk)

Jake Turner (jake.turner@warwick.ac.uk)

Question 1Define autoimmunity ( 4 marks)

1) WHAT? An immune response to self antigens

2) WHY? Due to a failure of immunological tolerance

3) IT CAUSES? Leading to immune-mediated damage to specific tissues

4) CAUSED BY? Usually due to a combination of genetic & environmental factors

Question 2What is tolerance? (1 mark)

Name TWO types of tolerance (think: location) (2 marks)

Give TWO mechanisms of central tolerance (2 marks)

Unresponsiveness of the immune system to an antigen

CentralPeripheral

Clonal deletion (by apoptosis)Clonal anergy (inactivated by regulatory T lymphocytes)

Question 3 Environmental causes of autoimmune conditions:

Explain how the following could lead to autoimmune disease:(a) Streptococcal infection → Rheumatic fever (2 marks)(b) Trauma to eye (2 marks)

(b) Trauma causes antigens to be revealed which are normally sequestered from immune system. Body has NOT developed tolerance to these self-antigens, so autoantibodies react

(a) Cross-reaction of antibodies against streptococci with myocardial antigen/heart valve antigen causing heart valve damage. An example of molecular/antigen mimicry

Question 4a Name the following signs of autoimmune conditions

A B C

1 mark 1 mark 3 marks

i

ii

iii

Autoimmunity Quiz

Question 4b Identify the likely autoimmune condition from the sign

A B C

1 mark 1 mark 1 mark

Autoimmunity Quiz

Question 4c Identify an autoantibody raised in this condition

A B C

1 mark 1 mark 1 mark

Question 4 : Answers

A B C

Sign: Exopthalmos Disease: Grave’s Disease AA: TSHR autoantibodies

Sign: Butterfly rash (note nasolabial groove sparing)

Disease: Systemic Lupus Erythematosus AA: ANA e.g. anti-dsDNA,anti-cardiolipin

Signs: (i) Boutonnière deformity(ii) Ulnar deviation of MCP(iii) Swan-neck deformityDisease: Rheumatoid arthritisAA: RhF, anti-CCP

A ‘fun’ list Autoimmune conditionRheumatoid arthritis

Systemic Lupus Erythematosus

Sjögren’s / Sicca syndromeMyasthenia GravisGrave’s Disease

Hashimoto’s thyroiditisCoeliac Disease

Elevated antibodiesRhF (rheumatoid factor), anti-CCP (anti cyclic citrullinated protein)

ANA (anti-nuclear antibody) e.g. anti-dsDNA (anti double-stranded DNA), anti-cardiolipin

RhF, ANA e.g. anti-Ro, anti-LanAChR (nicotinic acetylcholine receptor) antibodiesTSHR (thyroid stimulating hormone recepetor)

antibodies

Anti-thyroid perioxidaseAntigliadin

N.B. I’ve used acronyms: remember in an exam WRITE EVERYTHING OUT IN FULL!

Question 5Describe the joint position of a finger in: (a) Swan neck deformity (b) Boutonnière deformity

Question 6a A patient with Rheumatoid arthritis presents with:- Dry mouth- Scratchy, dry eyes- Rashes

Sjögren’s Syndrome / Sicca Syndrome

Bonus Marks

List TWO diagnostic tests

• Schirmer’s test • Slit lamp examination • Saliva flow test• Autoantibodies (anti-La = most specific)• Ultrasound of salivary glands (hypoechoic lesions & loss of tissue)• Biopsy of lip or salivary gland (lymphocytic infiltration tissue damage & loss)

Which secondary autoimmune condition should be suspected?

XerostomiaXerophthalmia

N.B. Sjorgren’s / Sicca can also present on its own, i.e. as a primary condition

N.B. Be able to describe these (just a sentence)

Medical terms

Autoimmunity Quiz

Question 6bSicca / Sjögren’s Syndrome:State THREE treatments/management

CONSERVATIVE

MEDICAL

SURGICAL

Artificial tears, regular sips of fluid, artificial saliva, (awareness of lymphoma risk)

DMDs: Topical cyclosporin

Lacrimal plugs

Autoimmunity Quiz

Question 7Grave’s Disease:State THREE treatments/management

CONSERVATIVE

MEDICAL

SURGICAL

N/A

1. Thioamides: Carbimazole or propylthiouracil (inhibt thyroid peroxidase enzyme required to convert iodine → thyroid hormone)

2. Radioiodine

Partial or total thyroidectomy

Autoimmunity Quiz

Clarifications

Exopthalmos = “appearance of protruding eyes” caused by proptosis (eye protrudes beyond orbit) and lid retraction

Thyrotoxicosis = excess thyroid hormone

Usually due to hyperthyroidism

Most common cause is Grave’s disease