y What

is an autoimmune disease?

pathology
Ab Ag

CELL

Co ple e t pathway

Ag-Ab complex

Ab ediated receptor bi di g of phagocytic cell

CELL LYSIS

AB MEDIATED CYTOTOXICITY

ETIOLOGY
EXT FACTORS
Infectious agents Vaccines,drugs Food & envmt allergens etc Breed predisposition
A U T O I M M U N E D I S E A S E S

GENETIC FACTORS

AUTOIMMUNE HEMOLYTIC ANAEMIA (AIHA) & THROMBOCYTOPENIA

60% - thrombocytopenia y associated ith SLE in dogs y Also ith lymphoreticular malignancy in cat y RICKETTSIA- idiopathic
y

classification
Peracute y Acute/subacute y Chronic y Pure red cell aplasia
y

PERACUTE
y y y y y y

ACUTE Cocker spaniels y Pallor , fatigue y Icterus less common y Hepatospleenomegaly

y

Middle aged, larger breeds Acute depression Variable icterus & Hburia Nonresp anaemia- become resp in 3-5 days Thrombocytopenia & thrombotic phenomena Prognosis poor even ith prompt therapy

WBC o due to BM hyperplasia y Responds ell to glucocorticoids/cytotoxic drugs

y

CHRONIC y common in cats than dogs y Severe cases unresponsive y BM- normal / hyperresponsive y Glucocorticoids &/or cytotoxic drugs

PURE RED CELL APLASIA y In pups & adults y Unresponsive anaemia y Glucocorticoids &/or cytotoxic drugs
y

AUTOIMMUNE THROMBOCYTOPENIA
Dogs , esp y Can occur concurrently ith AIHA (EVANS SYNDROME)
y

Melena,haematuria,epistaxis

ANAEMIA

DIAGNOSIS
Hematology y moderate to severe regenerative anemia y anisocytosis y polychromasia y high reticulocyte count (> 120G/L) y increased numbers of nucleated RBC

Autoagglutination is visible on the sides of the blood tube.

Microscopic agglutination in blood smear

rouleaux

spherocyte

o serum total bilirubin concentration Leukocytosis ( ith neutrophilic left shift and toxic changes)

COOMBS TEST (DAT)

TREATMENT
SUPPORTIVE THERAPY y Cage rest y Blood transfusion- controversial! y Aspirin- 0.5 mg/kg

INITIAL IMMUNOSUPPRESSIVE THERAPY y Methylprednisolone:2-4 mg/kg od follo ed by pred@ 1-2 mg/kg po bid for a minm of 7-10 days y Weekly monitoring until anaemia resolves y Tapered by 50% every 2 ks over a 3month pd (hematocrit>30%,-ve DAT)

SPECIFIC TREATMENT Immunosuppressive therapy  Azathioprine@2mg/kg po od + glucocorticoids available as IMURAN50mg tab AZORAN25mg,50mgtab Leflunomide@4mg/kg - tolerated Available as CLEFT10mg,20mg tab Danazol-5mg/kg po tid Available as DANOGEN 50,100& 200mg cap
y

OTHER TREATMENT y doxycycline@10 mg/kg for 28 d in endemic areas

y

MYASTHENIA GRAVIS

ACQUIRED MG y 2-3 years of age or older than 9 years y less common in intact male dogs (possibly due to testosterone influence)
y

y y y y y y y

EXTREME GENERALISED MUSCULAR WEAKNESS(o durin xercise & improve id rest) MEGAOESOPHAGUS(80-90%) dysphony (altered barking sound) mimical changes due to affected facial muscles tetraparesis dyspnea Possible complications of a mega-oesophagus: -concurrent regurgitation -aspiration pneumonia

DIAGNOSIS y Administration of a short-acting AChEsterase Inhibitor: Edrophonium chloride 0.1-0.2 mg/kg Tensilon IV; several minutes later an improvement of the C.S y EMG: diminishing muscle response on repetitive stimulation y Detection of serum auto-antibodies that react acetylcholine receptors

TREATMENT y Oral long-acting ACh-Esterase Inhibitor: Pyridostigmine bromide 1-3 mg/kg Orally q 8-12 hrs. available as MYESTIN 30mg,60mg tab

Intramuscular long-acting ACh-Esterase Inhibitor: Neostigmine 0.04 mg/kg IM q 6 hours. available as TILSTIGMINE 0.5mg/ml inj, 15mg tab y Immune-suppressive drugs (corticosteroids) - controversial in patients ith aspiration pneumonia.
y

AUTOIMMUNE SKIN DISEASES

ACANTHOLYSIS seperation

of

epidermal cell

PEMPHIGUS COMPLEX
Pemphigus foliaceous y pemphigus vulgaris y pemphigus vegetans y Pemphigus erythematosis
y

vesico-bullous, erosive to ulcerative skin disease y Vesicles- rarely seen in dogs/cats ( due to the thinness of the canine/feline epidermis as compared to humans)
y

PEMPHIGUS FOLIACEUS
lesions quickly become secondarily infected y common sites - body trunk (hindlimbs) y face y ears y feet (including pads) y Mucocutaneous junctions y nasal region y It is normally not seen in the oral cavity
y

DISCOID LUPUS
benign form of SLE. y Lesions are usually confined to the face y depigmentation, y erythema y excess scale over the nasal region. y ulceration y UV light deteriorates the condition y Breed predispositions-German shepherds
y

SYSTEMIC LUPUS ERYTHEMATOSES

Auto-antibodies against numerous different cell types y Vesicles/bullae and ulcers - face, ears, nose, distal limbs and feet y Secondary pyoderma & seborrheic skin disease are occasionally present y Pruritus y ulceration or hyperkeratosis of the foot pads.
y

Shifting lameness y Polymyositis y glomerulonephritis

y

DIAGNOSIS

TREATMENT
Systemic glucocorticoids/topical hydrocortisone sprays (e.g. Cortavance) y Azathioprine y Gold therapy (chrysotherapy) y Cyclophosphamide @2.2mg/kg/day po available as CYPHOS 200mg,500mg,1g vial ENDOXAN-ASTA tab 50mg
y

Contd Contd
Miscellaneous drugs y Interferons y Vitamin E y Tetracycline and nicotinamide y Mycophenalate mofetil - inhibits purine biosynthesis y Human Igs

Additional strategies y antimicrobial and anti-seborrheoic agents. y the use of appropriate sun-block preparations y avoidance of peak-time exposure to UV

CONCLUSION

Goal

yWhat

e can do?

THE KEY TO HEALTH LIES IN PURE FOOD, AIR,AND WATER.