IMMUNE COMPLEX DEPOSITION AND COMPLEMENT MEDIATED LYSIS.Q. Discuss the predispositions of SLE?Ans:
Role of genetics
: evidences are as follows ----
SLE is associated with HLA DR2 & DR3.
SCLE is associated with HLA B8, DR3.
DLE is associated with HLA B7, B8, DR2, DR3, DQA0102.
Genetic deficiencies of complement components
including C2,C3,C4,C5 & C1 esterase inhibitor------- are associated with DLE & SCLE.
TNF-α gene polymorphisms
are implicated ---- this promotes TNF-α production ---- photosensitivity.
Role of UVL
: it is the most important environmental factor in the induction of LE (UVB> UVA). Mechanismsinvolved are :
injures keratinocytes ----- autoantigen release
.( antigens expressed on the surface)
alters cellular DNA ---- immunogenic
exaggerated release of immune mediators
such as ---- IL-2, TNF-a, PGE, proteases, freeradicals, histamine.
expression of adhesion molecule--- ICAM 1
--- increased vascular permeability andexudation of inflammatory cells.
T cells and Langerhans cells
which suppress abnormal patterns of cutaneous inflammation.
Role of tobacco
: presence of LUPOGENIC AROMATIC AMINO AMINES
Role of drugs
: Induces T cell DNA hypomethylation ---- biological autoreactivity of lymphocytes. SKIN ISOFTEN SPARED IN DRUG INDUCED SLE.
(5)Role of viruses :
Induce virus induced apoptosis ---- expression of sequestered antigens on the cell surface.
EBV causes the overexpression of bcl-2 in the viral infected B cells ---- uncontrolled growth of B cells.
: evidences are :
more in women
Precipitation of disease with OCP.
: CADMIUN, GOLD AND MERCURY are associated with autoimmunity
silicon breast implant
: associated with ---
lupus like syndrome
autoimmune thyroid disease
hemolytic anemia and high titers of ANA and anti – ds DNA antibodies are reported following ingestionof sprouts, alphalpha which contains the amino acid ------
.Q. Discuss the ARA criteria for the diagnosis of SLEAns: There are 11 criteria of which 4 must be there to make a diagnosis. SENSITIVITY AND SPECIFICITY IS
1. MALAR RASH( 50%)
It is a fixed erythema, flat or raised over the malar area tendingto spare the nasolabial folds.
2. DISCIOD RASH(25%)
Erythematous raised patches with adherent keratotic scalingand follicular plugging; atrophic scarring may occur in olderlesions.
Skin rash as a result of unusual reaction to sunlight by patienthistory or physician observation.
4. Oral ulcer (25%)
Usually painless, observed by a physician.