Introduction

Condition where the body produces autoantibodies

and immunologically competent T-lymphocytes against its own tissues. Structural or functional damage of tissues.

Mechanisms
Hidden or Sequestered antigens : Eg : lens antigen of eye, sperm. Antigens present in closed systems no exposure to immune apparatus. Cataract surgery, injury damage of lens. Mumps orchitis.

Antigen alteration : Alteration of antigens by physical, chemical, biological changes Neo-antigens. viruses, intracellular pathogens alteration of cell surface antigens.

Cross reacting foreign antigens : Sharing of antigens by different organisms. Streptococcus (M protein) and heart muscle leading to rheumatic fever. Nephritogenic strains of Streptococci glomerulonephritis. Cross reaction between human and sheep brain antigens encephalitis.

Forbidden clones : Clone of cells bearing specific antibody pattern reactive against self antigens is destroyed during embryonic life. Persistence of forbidden clones autoimmune diseases.

T and B cell defects : Enhanced T helper cell function, decreased T suppressor cell function. Polyclonal activation of B cells. Nonspecific antibody production.

Classification of autoimmune diseases

Classified into : Haemocytolytic

Localised/organ specific Systemic/non-organ specific

Haemocytolytic Diseases
Involve cells in blood circulation.
Types : Autoimmune haemolytic anaemia

Idiopathic thrombocytopenic purpura Autoimmune leucopenia

Autoimmune haemolytic anemias : Autoantibodies against erythrocytes. Red cells coated with Abs prematurely destroyed in spleen, liver. Autoimmune thrombocytopenia : Autoimmune leucopenia

Localised Diseases
Specific organs are targets.
Types : Graves disease (Thyrotoxicosis)

Addisons disease Myasthenia gravis Pernicious anaemia

Graves disease : Anti-TSH receptor antibodies Long acting thyroid stimulators(LATS) combine with surface membrane of thyroid cells excessive hormone secretion.

Addisons disease : Presence of circulating antibodies against adrenal cells. Myasthenia gravis : Ab against acetyl choline receptors. Abnormal fatiguability of muscles Malfunction of myoneural junction.

Pernicious anemia : Abs against parietal cells achlorohydria, atrophic gastritis. Lack of IF prevents absorption of vitamin B12.

Systemic Diseases
Immune response against variety of self antigens.
Damage to several organs and tissue systems.

Types : Systemic lupus erythematosus

Rheumatoid arthritis

Systemic lupus erythematosus : Chronic multisystem disease. Autoantibodies against cell nuclei, intranuclear protiens. Rheumatoid arthritis : Presence of circulating autoantibody against IgG called RF. Symmetric polyarthritis with joints damage, myocarditis, vasculitis etc More common in women.

Pathogenesis
Cellular or humoral immune response against self

antigens. Autoantibodies inflammation and tissue injury. Damage by type 2 or type 3 reactions. Progression of autoimmune diseases are arrested by immuno suppressive therapy.