This document discusses autoimmune diseases, including their causes, symptoms, diagnosis, and treatment. It covers two types of autoimmune diseases: organ-specific and systemic. For organ-specific, it describes Graves' disease and type 1 diabetes. For systemic, it describes rheumatoid arthritis and ankylosing spondylitis. The causes involve genetic factors like certain HLA alleles that can make one susceptible. Symptoms, diagnosis, and treatments are provided for each disease.

1. AUTOIMMUNITY
Prof. R. MUTHUPPANDI
PG and Research Department of Zoology
Vivekananda College
Tiruvedakam west
Madurai – 625 234
INDIA
Note: Applicable for M.Sc. Students

2. SYNOPSIS
1. Principle
2. Organ specific autoimmune diseases and their treatment
i. Graves’ disease
ii. Type 1 diabetes
3. Systemic autoimmune diseases and their treatment
A. Rheumatoid arthritis
B. Ankylosing spondylitis

3. 1. Principle
• Due to mutatic polymorphism among alleles in the HLA system
(which is sole response for adaptive immunity), the
autoantibodies(IgM) are formed causing damage in the own tissues
leading to autoimmune diseases (so called autoimmunity).
• Some of such polymorphic HLA alleles make the possessor prone to
some infections leading to infectious diseases, while others are
protective to many diseases.

4. 2. Organ specific autoimmune diseases and their treatment:
If an autoimmune disease impacts only one organ it is termed as organ specific
autoimmune disease.
i. Graves’ disease:
Cause: In this disease, the HLA – B allele of MHC class I and HLA – DR3
allele of MHC II cause the production of autoantibody - thyroid stimulating
immunoglobulin (TSI) or TSH – receptor.
1. This TSI binds to the receptor of thyroid stimulating hormone (TSH) and
stimulates thyroid gland to produce too much thyroid hormones – T3 or T3 and
T4 hormones leading to hyperthyroidism, in turn increased metabolism.
2. Symptoms: a) Loss of weight (due to the increased metabolism), b) Enlarged
thyroid gland, c) Bulging of eyes(Graves’ ophthalmopathy), d) Changes in
menstrual cycle, e) Anxiety and irritability, f) Rapid heart beat (palpitations),g)
Increased bowel (frequent defecation), etc.

5. Diagnosis of Grauuves’ disease:
Physical examination:
• Swelling around the eyes and legs
• Slower reflexes
• Slower heart rate
Blood Tests:
Hypothyroidism is detected by blood tests for TSH level:
• The 0.4 mU / L to 4.0 mU / L is the reference range. But, TSH
measures > 4.0 mU/L of T4 level indicates hypothyroidism.

6. Treatment of Graves’ disease:
1. Anti -thyroid drugs like carbimazole can be administered in the
doze of 15 – 20 mg/8 hours for 3 – 4 weeks.
2. Palpitation, anxiety, increased bowel, etc. can be treated by
administrating propranolol 40 mg / 8 hours.
3. In advanced cases, the anti - thyroidal regions can be surgically
removed.
ii. Type 1 diabetes (T1D):
Cause:
a) It is a heritable autoimmune genetic disorder caused by the
association of HLA - DQ and HLA – DR alleles with this disease.
b) In T1D, the β cells in the pancreas are destroyed f by immune
system.

7. Symptoms of type 1 diabetes:
The following are the common symptoms of T1D:
• Extreme thirst
• Increased hunger (especially after eating)
• Dry mouth
• Upset stomach(nausea - குமட்டல், indigestion),and vomiting
• Frequent urination
• Heavy weight loss, even though patient eating well and feel hungry
• Fatigue (களைப்பு)
• Blurry vision
• Heavy, labored breathing(difficult to breath)

8. Diagnosis of T1D:
• An optimal blood pressure level is 120/80 mmHg.
• Readings over 120/80mmHg and up to 139/89mmHg are in the high range.
• At initial stage of type 1 diabetes random blood glucose test can be done
in which there won’t be rise in blood sugar or a simple urine test can be
done which doesn’t normally contain trace of glucose.
Fasting plasma glucose (FPG) test:
Normally, fasting blood sugar levels remain between 70 and 100 mg/dL.
Fasting blood sugar level will be 126 mg/dL or higher in T1D patients.

9. Treatment of T1D:
The T1D patients need life – long insulin therapy.
The main objective of the treatment is to keep before meals blood sugar
between 80 and 130 mg / Dl and after meals not higher than 180 mg / Dl.
 It is achieved by administering 4 types of insulin based on need
viz, 1. Short acting regular insulin. eg. Humulin R, and Novalin R
2. Rapid acting insulin. eg. Gluisine (Apidra), lispro (Humalog),
and Aspart (Novolog).
3. Intermediate acting insulin. eg. NPH (Novolin N, and
Humulin N
4. Long acting insulin. eg. Glargine (Lantus. Toujeo,Solostar),
detemir (Levemir), and degludec (Tresiba).

10. 3. Systemic autoimmune diseases and their treatment:
If an autoimmune disease impacts more than one organ or organ system at a time, it is termed as
systemic autoimmune disease
A. Rheumatoid arthritis:
Cause:
• HLA alleles associated with Rheumatoid arthritis are HLA class II molecules, viz, HLA -
DRB1*01, HLA - DRB1*04, HLA - DRB1*13,and HLA - DRB1*15 making the patients
susceptible to this disease.
• These alleles make the patients prone to infections by microbes like mycobacteria, mycoplasma,
Parvovirus B – 19, Epstein Barr virus, lentivirus, herpes virus, retrovirus, human T cell leukemia
virus, and cytomegalo virus
Symptoms:
 Onset of the symptoms is unnoticeable.
 After the period of a week or months the common symptoms are,
• The joints tend to have the muscular pain and stiffness

11. • Tiredness
• Acute fever
• Rapid movements of joints in fingers and toes
• Swelling of proximal interphalangeal joints, wrists, elbows, shoulders, ankles, and
knees
In advances cases, the symptoms are,
Muscular stiffness
Muscle pain and spasm(இழுப்பு)
Appearance of sub – cutaneous nodule on the surface of the fore arm

12. Diagnosis of Rheumatoid arthritis:
 Radiological examination shows the demineralization in the affected joints
 Waaler – Rose Bicolor test: It is a haemagglutination test involving the qualitative
and semi – quantitative detection of IgM in the sera of the patients
 Rheumatoid Factor: It is the detection of Rheumatic factors in serum is an
indication of the disease.
Treatment of Rheumatoid arthritis:
There is no cure for Rheumatoid arthritis but the symptom can possible be
lowered
The anti inflammatory drug aspirin can be administered.
Flufenamic acid, mefenamic acid, ibuprofen, naproxen, indomethacin,
phenylbutazone, methotrexate, and nimisulide can be given.

13. B. Ankylosing spondylitis(மடங்காதநிலை முதுககலும்பு வீக்கம்):
Cause: HLA – B27 has a close association in causing this autoimmune disease.
• This is an inflammatory disease characterized by fusion of vertebrae becoming
less flexible resulting in hunched forward posture
Symptoms:
The affected areas are,
• The joint between the base of spine and pelvis
• The vertebrae in the lower back
• The places where tendons and ligaments attach to bones, mainly in the spine, but
sometimes along the back of the heel
• The cartilage between the breastbone and ribs
• Hip and shoulder joints

14. Diagnosis of ankylosing spondylitis:
Lab tests:
• Blood sample is tested for the HLA – B27 allele, and for markers of inflammation.
Imaging tests:
• X Rays show the changes in the joints and other bones.
• MRI scan: Radio waves and strong magnetic field give detailed images of bones
and soft tissues.
Treatment of ankylosing spondylitis:
The non – steroidal anti – inflammatory drugs(NSAIDs like Naproxen
(Naprosyn), indomethacin (Indocin, and tivorbex) are used to relieve
inflammation, pain, and stiffness.
On non – function of NSAIDs, inhibitors of interleukins esp. for interlukin – 17
(IL – 17) are used against infections and ilflmation.