AUTOIMMUNE DISORDERS
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Many, but not all, autoimmune disorders, affect a preponderance of female
patients, with three times as many females as males presenting with
autoimmune diseases. The reasons for this gender bias are unclear but may be
related to sex hormone levels. Many autoimmune disorders show a link with
the type of MHC antigens that are present on cells. In humans, the MHC is
known as the HLA system. The links between HLA type and different diseases
is described in Chapter 6. So, for example, patients with Goodpasture’s
syndrome have a higher incidence of HLA-DR2 than the healthy population.
Autoimmune Disorders Affecting Endocrine Glands
Autoimmune disorders of the thyroid gland are among the most common
autoimmune disorders. Some will be discussed in Chapter 7. Autoimmune
thyroiditis, also known as Hashimoto’s thyroiditis, results in hypothyroidism
and myxedema. The disease presents, typically, in women of middle age
who are overweight, lethargic, constantly feel cold, are constipated and have
coarse, dry hair and skin. The thyroid is swollen with a generally painless
goiter, but which has a rubbery consistency when palpated. A biopsy of
the thyroid shows infiltration with both CD8+ and CD4+ T lymphocytes
that progressively destroy the thyroid gland. Patients also have antibodies
to thyroglobulin and to thyroid peroxidase, which can be determined by
Type of disorder Example Effect of disorder Autoantibodies present Autoreactive T cells
Organ specific autoimmune
hemolytic anemia
destruction of erythrocytes
(Chapter 13)
antibodies to erythrocyte
antigens
autoimmune thyroiditis hypothyroidism
(Chapter 7)
antibodies to thyroglobulin and
thyroid peroxidase
TH1 cells specific for thyroid
antigens
Addison’s disease adrenal insufficiency
(Chapter 7)
antibodies to cytoplasmic antigens
of cells of adrenal cortex
infiltration of adrenal cortex with
autoreactive T cells
type 1 diabetes mellitus destruction of insulin-producing
cells in pancreas; serious
metabolic disturbances
antibodies to islet cells found in
classical juvenile form
infiltration of pancreas with
autoreactive T cells
Goodpasture’s syndrome progressive kidney and lung
damage
antibodies to basement membrane
antigens of kidney and lung
Graves disease hyperthyroidism
(Chapter 7)
antibodies to thyroid stimulating
hormone receptors
destruction of thyroid cells by
autoreactive T lymphocytes
myasthenia gravis progressive muscle weakness antibodies to acetyl choline
receptors on muscle cells
pernicious anemia failure to absorb vitamin B 12
in the stomach
(Chapters 11and 13 )
antibodies to intrinsic factor
Systemic disease rheumatoid arthritis (RA) inflammatory disorder affecting
joints, skin and internal organs
antibodies to IgG (rheumatoid
factor)
infiltration of joints with
autoreactive T lymphocytes
systemic lupus
erythematosus (SLE)
inflammatory disorder affecting
multiple organ systems
antibodies to DNA, chromatin
and histones;
rheumatoid factor in some
individuals
evidence of T cell reactivity in
some of the many organs affected
multiple sclerosis (MS) inflammatory disorder
affecting central nervous system
antibodies to myelin basic protein destruction of myelin membrane
by autoreactive T lymphocytes
Table 5.7Some examples of autoimmune disease