Autoimmune Disease: Autoimmune Disease: LupusLupus

By: Remi Coker and Ashley Robinson By: Remi Coker and Ashley Robinson

The Immune SystemThe Immune SystemInnate vs. Adaptive ImmunityInnate vs. Adaptive ImmunityCellsCells

Phagocytes – engulf pathogen, produce Phagocytes – engulf pathogen, produce cytokinescytokines

B Cell – AbB Cell – Ab T cell – activate B cellsT cell – activate B cells

Attack pathogenAttack pathogen

ComplementComplement Clear immune complexes and apoptic cellsClear immune complexes and apoptic cells Classical – Ag-AbClassical – Ag-Ab Alternative – bacterial polysaccharidesAlternative – bacterial polysaccharides

AntibodiesAntibodies NeautralizeNeautralize OpsonizeOpsonize Activate complementActivate complement

CytokinesCytokines ChemokinesChemokines

InflammationInflammationApoptosisApoptosis

Programmed Cell deathProgrammed Cell death

Immunity – AutoimmunityImmunity – Autoimmunity

What is autoimmunity?What is autoimmunity? Recognition of “self” as a Recognition of “self” as a

pathogen – invaderpathogen – invader Examples: insulin Examples: insulin

dependant diabetes, lupus, dependant diabetes, lupus, rheumatoid arthritis, rheumatoid arthritis, multiple sclerosis, multiple sclerosis, sclerodermascleroderma

Genetics and the Genetics and the environment (i.e.. environment (i.e.. Chemicals, sun exposure) Chemicals, sun exposure) combine to cause diseasescombine to cause diseases

The Complement Cascade SystemThe Complement Cascade System

““Complement is a part Complement is a part of the innate immune of the innate immune system and underlies system and underlies one of the main one of the main effector mechanisms effector mechanisms of antibody-mediated of antibody-mediated immunity.”immunity.”

What is Lupus?

Lupus is an autoimmune disease that can affect many parts of body and affects each person differently. There are three main types of lupus:

Systemic lupus erythematosus is the most common form. It's sometimes called SLE, or just lupus. The word "systemic" means that the disease can involve many parts of the body such as the heart, lungs, kidneys, and brain. SLE symptoms can be mild or serious.

Discoid lupus erythematosus mainly affects the skin. A red rash may appear, or the skin on the face, scalp, or elsewhere may change color.

Drug-induced lupus is triggered by a few medicines. It's like SLE, but symptoms are usually milder. Most of the time, the disease goes away when the medicine is stopped. More men develop drug-induced lupus because the drugs that cause it, hydralazine and procainamide, are used to treat heart conditions that are more common in men.

Symptoms of LupusSymptoms of Lupus

Lupus is hard to diagnose and is often mistaken for other diseases giving it Lupus is hard to diagnose and is often mistaken for other diseases giving it the name the “great imitator”. The signs of lupus differ from person to the name the “great imitator”. The signs of lupus differ from person to person. Some people have just a few signs, while others have more. Some person. Some people have just a few signs, while others have more. Some symptoms include:symptoms include:

Painful or swollen joints

Unexplained fever

Chest pain with deep breathing

Swollen glands

Extreme fatigue

Discoid rash (red raised patches)

Seizures

Unusual hair loss (mainly on the scalp)

Arthritis

Photosensitivity

Low blood count

Depression, trouble thinking, and/or memory problems

Mouth ulcers

Malar Rash (red butterfly shaped rash over nose and cheeks)

Causes of LupusCauses of Lupus

The cause of lupus is unknown, however researches The cause of lupus is unknown, however researches believe that the disease is somehow genetically linked and believe that the disease is somehow genetically linked and the disease can be triggered. These triggers include the the disease can be triggered. These triggers include the your diet, the environment, other infectious diseases, and your diet, the environment, other infectious diseases, and stress. When these triggers activate the disease it causes stress. When these triggers activate the disease it causes “flares” and people can experience any of the symptoms of “flares” and people can experience any of the symptoms of lupus. Flares can occur for short or extended periods of lupus. Flares can occur for short or extended periods of time and then go into a remission and not see any time and then go into a remission and not see any symptoms for a period of time.symptoms for a period of time.

Who Gets Lupus?Who Gets Lupus?

Anyone can contract lupus, however 9 out of 10 people Anyone can contract lupus, however 9 out of 10 people with lupus are women. African American, Hispanic, and with lupus are women. African American, Hispanic, and Asian women have a higher likelihood of getting lupus. Asian women have a higher likelihood of getting lupus. Also these women have more complicated symptoms Also these women have more complicated symptoms then Caucasian women. Lupus is most common in then Caucasian women. Lupus is most common in women ages 15-44 years old and this causes when women ages 15-44 years old and this causes when women are able to have children and this causes women are able to have children and this causes scientist to believe that women’s hormones may have scientist to believe that women’s hormones may have something to do with the disease although men can something to do with the disease although men can contract the disease as well. contract the disease as well.

Treatments for LupusTreatments for Lupus

The current treatment for lupus is drug therapies specific to the The current treatment for lupus is drug therapies specific to the symptoms the patient is experiencing. However, some drugs symptoms the patient is experiencing. However, some drugs have side effects and doctor’s are researching new treatments have side effects and doctor’s are researching new treatments for lupus. Preventive measures can reduce the risk of flares. For for lupus. Preventive measures can reduce the risk of flares. For photosensitive patients, avoidance of excessive sun exposure photosensitive patients, avoidance of excessive sun exposure and/or the regular application of sun screens will usually prevent and/or the regular application of sun screens will usually prevent rashes. Regular exercise helps prevent muscle weakness and rashes. Regular exercise helps prevent muscle weakness and fatigue. Immunization protects against specific infections. fatigue. Immunization protects against specific infections. Support groups, counseling, talking to family members, friends, Support groups, counseling, talking to family members, friends, and physicians can help alleviate the effects of stress. and physicians can help alleviate the effects of stress. Pharmaceuticals used for lupus symptoms include:Pharmaceuticals used for lupus symptoms include:

NSAIDs (Non-Steroidal Anti-Inflammatory Drugs): NSAIDs (Non-Steroidal Anti-Inflammatory Drugs): Aspirin, Motrin, Naprosyn, Arthrotec, Aspirin, Motrin, Naprosyn, Arthrotec, Indocin, Relafen, TolectinIndocin, Relafen, Tolectin

Acetaminophen: Acetaminophen: TylenolTylenol

Corticosteroids: Corticosteroids: Prednisone Prednisone

Antimalarials: Antimalarials: Aralen, PlaquenilAralen, Plaquenil

Immunomodulating Drugs: Immunomodulating Drugs: Imuran, CytoxanImuran, Cytoxan

Anticoagulants: Anticoagulants: Aspirin, Heparin, Coumadin Aspirin, Heparin, Coumadin

BibliographyBibliography

Web sites:Web sites:www.lupus.orgwww.lupus.orgwww.hamline.edu/~lupus/www.hamline.edu/~lupus/www.aarda.orgwww.aarda.org http://www.niams.nih.gov/hi/topics/lupus/shades/index.htm#1http://www.niams.nih.gov/hi/topics/lupus/shades/index.htm#1

http://www.healthsystem.virginia.edu/internet/rheumatology/lupus.cfmhttp://www.healthsystem.virginia.edu/internet/rheumatology/lupus.cfm

http://www.muschealth.com/infectious/immune.htmhttp://www.muschealth.com/infectious/immune.htm

http://www.uklupus.co.uk/dxlupus.htmlhttp://www.uklupus.co.uk/dxlupus.html

Books:Books:

Chapter 5.1: The Immune SystemChapter 5.1: The Immune System

Systemic Lupus Erythematosus by Rosalind Ramsey-Goldman and Susan Systemic Lupus Erythematosus by Rosalind Ramsey-Goldman and Susan Manzi Manzi

The Immune SystemThe Immune System, Peter Parham, Garland Publishers, 2000., Peter Parham, Garland Publishers, 2000. ImmunobiologyImmunobiology, Charles Janeway and Paul Travers, Garland , Charles Janeway and Paul Travers, Garland

Publishing, Publishing, 1999.1999.

ResourcesResources

The Ahearn Laboratory, at the Lupus Center of The Ahearn Laboratory, at the Lupus Center of Excellence is at the cutting edge, trying to Excellence is at the cutting edge, trying to develop a clinical assay to test for lupus. develop a clinical assay to test for lupus. Tracking different variations of the diseaseTracking different variations of the disease The role of complement and apoptosis in The role of complement and apoptosis in

autoimmunityautoimmunity

The Pittsburgh Tissue Engineering Institute and The Pittsburgh Tissue Engineering Institute and the University of Pittsburgh are also heavily the University of Pittsburgh are also heavily involved in determining a solution or at least a involved in determining a solution or at least a proper detection of lupus. proper detection of lupus.

Contact InformationContact Information

Joseph Ahearn, MDJoseph Ahearn, MD

Lynne WelshonsLynne Welshons

Biomedical Science Tower S705ABiomedical Science Tower S705A

School of MedicineSchool of Medicine

University of PittsburghUniversity of Pittsburgh

412.648.9782412.648.9782

Susan Manzi, MDSusan Manzi, MD

Judy WebbJudy Webb

Biomedical Science Tower S721ABiomedical Science Tower S721A

School of MedicineSchool of Medicine

University of PittsburghUniversity of Pittsburgh

412.383.8734412.383.8734

V. Emily Stark, MSV. Emily Stark, MS Biomedical Science Tower S736ABiomedical Science Tower S736A School of MedicineSchool of Medicine University of PittsburghUniversity of Pittsburgh 412.648.9685412.648.9685