Question

vase 9rae rupua ryuveinuoua- A 26-year-old woman presented with paintul, stiff knees of 4 weeks duration. She had a 6-year history of Raynaud's phenomenon. On examination, she had bilateral effusions in both knee joints, but all oth er joints were normal. She had no skin lesions, muscle tendemess, proteinuria or fever. The results of relevant investigations are shown in Table C10.1. On the basis of these, a diagnosis of Systemic Lup us Erythematosus (SLE) was made and the patient treated with aspirin for her painful knees. She imp roved over 4 weeks and then remained symptom-free for 5 years. During this time, her antinuclear ant ibody remained positive at 1/80, her DNA-binding activity varied from 40 to 80 % , and her C3 and C4 levels were oocasionally low Later, she developed a bilateral, butterfly rash across her cheeks, blotch v rash on her hands and thighs, consistent with active vasculitis and also presented with proteinuria, h ematuria and glomerular nephritis. Her Raynaud's phenomenon concurrently became much worse. F ollowing treatment with prednisolone, the skin manifestations gradually disappeared and the steroids were taled off This patent presented with arthritis and Raynaud's phenomenon. She is unusual in that the arthrit is of SLE usually involves small joints, but it is important to note that she remained perfectly well without treatment for 5 years, despite persistently abnormal serology. Table of Values Associated with Case 1 (NR normal range) C-reactive protein Rheumatoid factor Antinuclear antibody dsDNA-binding activity Serum complement levels 8mgl (normal) Negative Positive (titer 1/80; IgG class) 80% ( NR 0-30% binding ) 0.35g1 (NR 0.65-1.30) 0.05g (NR 0.20-0.50) C3 (a complement protein) C4 (a complement protein) Serum immunoglobulins IgG 22.0g (NR 7.2-19.0) 3.8g/l (NR 2.0-5.0) 12g/i (NR 0.5-2.0) Granular deposits of IgG and complement at dermo - epidermal junction IgA IgM Biopsy of normal, sun-exposed skin Qupus band test) Questions for Case 1 1. Explain the immunological basis of her disease condition and the significance of her elevated levels of antinuclear antibodies (ANA) 2. Explain as to what caused her glomerular nephritis, vascultis and bilateral skin rash. 3. How would you categorize the type of hypersensitivity reactions causing the above disease? 4. Explain how prednisolone helped to treat the symptoms. 5. Explain the biochemical mechanism of action of aspirin in its interaction with cyclooxygenase. Which class of macromoleoules is affected by this interaction? State briefty a major side effect that may develop as a result of extensive aspirin therapy a. b Case 2- Immunodeficiency (You need to do your own research to help answer this question)

Answer 1

1, SLE is a multifactorial disease, is influenced by genetic, immunological, endocrine and environmental factors due to loss of immunological tolerance with self-antigens. It is an autoimmune disease in which the immune system produces autoantibodies. Antinuclear antibody(ANA) will be positive in SLE. it defines the feature of connective tissue disorders. ANAs are a class of antibodies that bind cellular components in the proteins and nucleus. The antibody binds double-stranded DNA due to incomplete removal of cellular material during apoptosis.
2, SLE has unknown etiology contain many clinical manifestations. cutaneous manifestations of LE based on immunohistology of skin lesions. it damages the cutaneous lupus erythematosus. Renal involvement in SLE patients due to the immune complex formation in the kidney makes intra-glomerulus inflammation. Antigen cause immune disease in lupus, cutaneous lesions in the small and large vessels cause vasculitis.
3, Type III hypersensitivity common in SLE. when antibodies produced against the protein, this antibody attack circulation. The tissue damage in antibody-antigen complexes are activators of the SLE. Typical sites of injury occur in the skin, kidney and mucous membrane. Due to the inflammatory reaction that blends the features of type II and III hypersensitivity with the formation of antigen-antibody complexes.
4, Prednisolone is a group of steroids, it has a group of chemicals with a large portion of hormone in the body. it is commonly prescribed for lupus, it lowers the symptoms in SLE. this reduces the activity of the immune system by affecting the functions of WBC. It reduces inflammation and immune response, prevent damage tissues in the body.