aspek klinik penyakit autoimun

8/19/2019 Aspek Klinik Penyakit Autoimun

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ASPEK KLINIK PENYAKIT

AUTOIMUN

Dr. Safari Wahyu Jatmiko


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GRAE!S DISEASE


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Graves' disease: Thi" i" th# mo"t $ommo% $au"# of hyrthyroi'i"m a%' i"

'u# to TS( r#$#&tor a%ti)o'i#" *I+G, that )i%' to th#thyroi' TS( r#$#&tor "timu-ati%+ thyroi' hormo%#&ro'u$tio% )#ha/i%+ -ik# TS(.

Th#"# TS( r#$#&tor a%ti)o'i#" $a% )# m#a"ur#' i%"#rum.

012 $o%$or'a%$# i" "##% amo%+"t mo%o3y+oti$ t4i%"4ith a 02 $o%$or'a%$# rat# i% 'i3y+oti$ t4i%".

th# i%itiati%+ #/#%t i% th# &atho+#%#"i" may )# a%

i%f#$tio% 5 i% a +#%#ti$a--y "u"$#&ti)-# i%'i/i'ua-*a"Yersinia enterocolitica Escherichia coli a%' oth#r Gram6%#+ati/# or+a%i"m" $o%tai% TS( )i%'i%+ "it#", )ut th#&r#$i"# i%itiati%+ m#$ha%i"m" r#mai% u%&ro/#% i% mo"t$a"#".


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77

PSORIASIS


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78

P"oria"i"

• T6$#-- m#'iat#' i%9ammatory '3 – E&i'#rma- hyr&ro-if#ratio% 8O to

a$ti/atio% of immu%# "y"t#m

– A-t#r#' maturatio% of "ki%

– I%9ammatio%

– a"$u-ar $ha%+#"


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7:


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7;DERMIS

STRATUM

BASALE

STRATUMSPINOSUM

STRATUM

GRANULOSUM

STRATUM

CORNEUM

Proliferation

Immaturity

Neutrophilaccumulation

DisorganizedNO

RMA

L

PS

ORI

ASIS


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70


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7<


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7=


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7>


19/46

Rh#umatoi' Arthriti"

• Th# &r#/a-#%$# of rh#umatoi' arthriti" i% mo"t?au$a"ia% &o&u-atio%" a&&roa$h#" 72 amo%+a'u-t" 7> a%' o/#r a%' i%$r#a"#" 4ith a+#a&&roa$hi%+ 82 a%' 02 i% m#% a%' 4om#%

r#"$ti/#-y )y a+#


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• @oth &r#/a-#%$# a%' i%$i'#%$# ar# 86: tim#"+r#at#r i% 4om#% tha% i% m#%

• Afri$a% Am#ri$a%" a%' %ati/# Ja&a%#"# a%'

?hi%#"# ha/# a -o4#r &r#/a-#%$# tha% ?au$a"ia%"

• S#/#ra- North Am#ri$a% Nati/# tri)#" ha/# a hi+h&r#/a-#%$#

• G#%#ti$ fa$tor" ha/# a% im&orta%t ro-# i% th#"u"$#&ti)i-ity to rh#umatoi' arthriti"


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• Rh#umatoi' arthriti" i" a% autoimmu%# 'i"#a"# i%4hi$h th# %orma- immu%# r#"&o%"# i" 'ir#$t#'a+ai%"t a% i%'i/i'ua-5" o4% ti""u# i%$-u'i%+ th#

oi%t" t#%'o%" a%' )o%#" r#"u-ti%+ i%

i%9ammatio% a%' '#"tru$tio% of th#"# ti""u#"

• Th# $au"# of rh#umatoi' arthriti" i" %ot k%o4% – I%/#"ti+ati%+ &o""i)i-iti#" of a for#i+% a%ti+#% "u$h a" a /iru"


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Immu%o-o+y

• Ma$ro&ha+#"B – Pro'u$# $ytoki%#" – ?ytoki%#" *TNC6, $au"#

"y"t#mi$ f#atur#" – R#-#a"# $h#moki%#"

r#$ruit PMN" i%to "y%o/ia-9ui'm#m)ra%#

• TNC6 F IL67B

– Pro-if#ratio% of T $#--" – A$ti/atio% of @ $#--" – I%itiat#"

&roi%9ammatoryoi%t6'ama+i%+ &ro$#""#"

• T(67 $#--"B – M#'iat# 'i"#a"# &ro$#""#" – A$ti/at# @ $#--"

• @ $#--"B – R#-#a"# $ytoki%#" – P-a"ma $#--" that &ro'u$#

A)

• O"t#o$-a"t"B – @o%# #ro"io% – Juta6arti$u-ar F Sy"t#mi$

o"t#o&oro"i"


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Patho&hy"io-o+y

• S4#--i%+ of Sy%o/ia- -i%i%+ – A%+io+#%#"i"

• Ra&i' 'i/i"io%+ro4th of $#--" H Pa%%u" – Sy%o/ia- thi$k#%i%+hyr&-a"ia – I%9ammatory /a"$u-ari3#' ti""u# – G#%#ratio% of M#ta--o&rot#i%a"#"

• ?ytoki%# r#-#a"# – I%-tratio% of -#uko$yt#" – ?ha%+# i% $#--6"urfa$# a'h#"io% mo-#$u-#" F $ytoki%#" – D#"tru$tio% of )o%# F $arti-a+#


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• D#"$ri&tio% – Mor%i%+ "ti%#""

– Arthriti" of : or mor# oi%t"

– Arthriti" of ha%' oi%t"

– Symm#tri$ arthriti"

– Rh#umatoi' %o'u-#"

– S#rum rh#umatoi' fa$tor

– Ra'io+ra&hi$ $ha%+#"

• A r"o% "ha-- )# "ai'

to ha/# rh#umatoi'arthriti" if h# or "h# ha""ati"#' ; of = $rit#ria4ith $rit#ria 76; &r#"#%tfor at -#a"t < 4##k"


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Diabetes MellitusType Diabetes


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What i" Dia)#t#"• Dia)#t#" M#--itu" th# &r#"#%$# of #-#/at#' +-u$o"# -#/#-" i% th# )-oo' 'u# to

a)"o-ut# or r#-ati/# i%"u$i#%$i#" of i%"u-i%• 7=7 mi--io% o&-# "u#r from 'ia)#t#"Type • Autoimmu%# '#"tru$tio% of th# β $#--" i% th# &a%$r#a" 4hi$h ar# u"#' to &ro'u$t i%"u-i%

7. I%"u-i% a'mi%i"tratio%Type !• ?om)i%atio% of '#f#$ti/# i%"u-i% "#$r#tio% a%' i%$r#a"#' i%"u-i% r#"i"ta%$#• G#%#ra--y "##% i% o/#r4#i+ht &ati#%t" *>02,•

Thou+ht that o)#"ity $o%tri)ut#" to i%"u-i% r#"i"ta%$# 'u# to "#$r#tio% of hormo%#"$a--#' a'i&oki%#" that im&air" +-u$o"# to-#ra%$#• U"#' to )# "##% i% o-'#r &ati#%t" %o4 'i"#a"# i" )#$omi%+ mor# &r#/a-#%t i% $hi-'r#%

a" o)#"ity +ro4" amo%+ $hi-'r#%7. Lif# "ty-# $ha%+#8. Ora- m#'i$atio%"

i. Im&ro/# i%"u-i% &ro'u$tio%ii. R#+u-at# a)%orma- r#-#a"# of +-u$o"# )y th# -i/#r

iii. D#$r#a"# i%"u-i% r#"i"ta%$#:. I%"u-i% a'mi%i"tratio%Gestational diabetes• I%"u-i% r#"i"ta%$# $au"#' )y hormo%#" 'uri%+ &r#+%a%$y• U"ua--y im&ro/#" or 'i"a&ar" aft#r +i/i%+ )irth• S##% i% 02 of &r#+%a%t 4om#%

7. Di#t $o%tro-


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(o4 'o o&-# +#t'ia)#t#"

Type • G#%#ti$ #-#m#%tmutatio% "u"$#&ti)i-ity to tri++#r"B

– ira- i%f#$tio%" – Str#"" – E%/iro%m#%ta- #&o"ur# 6 #&o"ur# to $#rtai% $h#mi$a-" or 'ru+"

• Whit# )-oo' $#--" T -ym&ho$yt#" &ro'u$# immu%# fa$tor" $a--#' $ytoki%#"4hi$h atta$k a%' '#"troy β $#--" of &a%$r#a"

• ?a% tak# =yr". or -o%+#r to '#/#-o& to a)"o-ut# )y th# tim# k%o4 "om#thi%+

i" 4ro%+ >12 6 12 of β $#--" ar# '#"troy#'• 712 $ha%$# of i%h#riti%+ if r"t '#+r## r#-ati/# ha" 'ia)#t#"• Mo"t -ik#-y to i%h#rit from fath#r• I%$r#a"# i%$i'#%$#" 4ou-' tak# at -#a"t ;11 y#ar" if +#%#ti$ fa$tor" 4#r# th#

o%-y $au"#"iruses

• I%f#$tio% i%tro'u$#" a /ira- &rot#i% that r#"#m)-#" a β $#-- &rot#i%• T6$#--" a%' a%ti)o'i#" tri$k#' )y thi" r#"#m)-a%$# i%to atta$ki%+ β &rot#i% a%' /iru"

• ?a"#" ri"i%+ i% $#rtai% ar#a" of U.S. &arti$u-ar-y North#a"t#r% r#+io%• ?o4!" mi-k $#rtai% &rot#i% 4hi$h may tri++#r atta$k o% β $#--"• @r#a"t mi-k hormo%#" 4hi$h &rot#$t )o'y from atta$k o% β $#--"Type !• I%h#rita%$# &att#r% r"t '#+r## r#-ati/#" 4ith ty 8 ha/# mu$h hi+h#r ri"k

for '#/#-o&i%+• P#rha&" i%h#riti%+ a t#%'#%$y to4ar'" o)#"ity "i%$# >02 o)#"#

Gestational• G#%#ti$a--y &r#'i"&o"#' ha/# +r#at#r $ha%$# for '#/#-o&i%+ ty 8 -at#r i%


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What ar# th# Si+%" a%'Sym&tom"

Polyuria *fr#u#%t uri%atio%,• G-u$o"# $o%$#%tratio% i% )-oo' i" hi+h• R#a)"or)tio% of +-u$o"# i% th# &roima- r#%a- tu)u-i i"

i%$om&-#t# +-u$o"# r#mai%" i% uri%#• O"moti$ &r#""ur# of uri%# i%$r#a"#"• I%hi)it" r#a)"or)tio% of 4at#r )y ki'%#y r#"u-ti%+ i%

i%$r#a"# uri%# &ro'u$tio%Dehydration• Lo"t 4at#r /o-um# i% ki'%#y r#&-a$#' from 4at#r h#-' i%

)o'y i%$r#a"#' thir"t a%' i%$r#a"#' 9ui' i%tak# 6&o-y'i&"ia

Polyphagia• I%$r#a"#' a&tit# %o +-u$o"# '#-i/#r#' to mu"$-#"

ti""u#" )o'y "#%'" "i+%a- to )rai% to #at "om#thi%+ tor#%ouri"h

#eight loss and $ea%ness• +-u$o"# $a%%ot &arti$i&at# i% $ri) $y$-# to )# u"#' a"

#%#r+y u"# of fat a" a-t#r%ati/# #%#r+y "our$#

"ision changes•


30/46

Im&orta%$# of ?o%tro- ?om&-i$atio%" of Dia)#t#"

Diabetic &etoacidosis• Cat )r#ak 'o4% a$$#-#rat#" a%' i%$r#a"# th# &ro'u$tio% of fatty a$i'"• Catty a$i'" $o%/#rt#' i%to k#to%# )o'i#"• K#to%#" ar# toi$ at hi+h -#/#-"• Sym&tom" 6 ra&i' '##& )r#athi%+ &o-yuria %au"#a /omiti%+ a)'omi%a- &ai%

a-t#r#' "tat#" of mi%' "u$h a" ho"ti-ity ma%ia $o%fu"io% -#thar+y a%' hy&ot#%"io%$oma '#ath

ypoglycemia•

Lo4 )-oo' "u+ar too mu$h i%"u-i% or %ot #%ou+h +-u$o"# to $o/#r i%"u-i% tr#atm#%t• Sym&tom" 6 "ym&ath#ti$ a$ti/atio% of th# auto%omi$ %#r/ou" "y"t#mB immo)i-i3#'

&a%i$ 'r#a' a+itat#' "4#aty "#i3ur#"(mputations• (#a- "-o4-y• Cai- to h#a-• I%f#$tio%"ascular diseases•

Dama+# to )-oo' /#""#-" – Dia)#ti$ r#ti%o&athy +ro4th of &oor ua-ity%#4 )-oo' /#""#-" i% r#ti%a r#ti%a- 'ama+# )-i%'%#""

– Dia)#ti$ %#&hro&athy 'ama+# to ki'%#y

$hro%i$ r#%a- fai-ur# 'ia-y"i"

• Dama+# to art#ri#" – ?oro%ary art#ry 'i"#a"# "trok# ri&h#ra- /a"$u-ar

'ia)#ti$ myo%#$ro"i" *mu"$-# 4a"ti%+!,

• Dia)#ti$ foot %#uro&athy a%' art#ria- 'i"#a"#


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Sy"t#mi$ Lu&u"

Eryth#mato"u"


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Lu&u"

• Systemic lupuserythematosus *a-"o $a--#'SLE or lupus, i" a%autoimmu%# 'i"#a"# of th#)o'y5" $o%%#$ti/# ti""u#". Autoimmune m#a%" that th#

immu%# "y"t#m atta$k" th#ti""u#" of th# )o'y. I% SLEth# immu%# "y"t#m &rimari-yatta$k" &art" of th# $#--%u$-#u".

•SLE a#$t" ti""u#" throu+houtth# )o'y. Ci/# tim#" a" ma%y4om#% a" m#% +#t SLE. Mo"to&-# '#/#-o& th# 'i"#a"#)#t4##% th# a+#" of 70 a%';1 a-thou+h it $a% "ho4 u& ata%y a+#.


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• Lu&u" H Autoimmu%ity – Sy"t#mi$ a%' a#$t" $o%%#$ti/# ti""u#

• ?au"#' )y ma-fu%$tio%" ofB

– T6$#--" – @6$#--"

– ?om&-#m#%t Sy"t#m

– Si+%a- Tra%"'u$tio%

• ?a% )# -#tha- or %ot

• U%iu# to #a$h i%'i/i'ua-


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G#%#ti$ A""o$iatio%"

• (LA!" ar# -o$i o% +#%#" that $o'# for$#rtai% Q $hai% o% th# M(? $om&-#

• (LA6DR8

• (LA6DR:

• (LA6D@7 I%/o-/#' i% m#'iati%+&ro'u$tio% of a%ti)o'i#" to '"6DNA


35/46

Mai% Patho-o+y

• Th# &-a"ma $#--" ar# &ro'u$i%+ a%ti)o'i#"that ar# "$i$ for "#-f &rot#i%" %am#-y'"6DNA

•

O/#ra$ti/# @6$#--"• Su&&r#""#' r#+u-atory fu%$tio% i% T6$#--"

• La$k of T6$#--"

•

A$ti/atio% of th# ?om&-#m#%t "y"t#m


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O/#ra$ti/# @6$#--"

• E"tro+#% i" a "timu-ator of @6$#-- a$ti/ity – Lu&u" i" mu$h mor# &r#/a-#%t i% f#ma-#" of

a+#" 706;0• (#i+ht of E"tro+#% &ro'u$tio%

• IL671 a-"o a @6$#-- "timu-ator i" i% hi+h$o%$#%tratio% i% -u&u" &ati#%t "#rum. – (i+h $o%$#%tratio% -i%k#' to $#-- 'ama+#

$au"#' )y i%9ammatio%


37/46

T6$#-- Ma-fu%$tio%"

• C$ r#+io% "4it$h –

– L#a'" to ma-fu%$tio% i% "i+%a-i%+ a%'

'#$r#a"#' IL68 &ro'u$tio%

• I%$r#a"#' -#/#-" of ?a8V

– L#a'" to "&o%ta%#ou" a&o&to"i"


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T6$#-- Si+%a- Tra%"'u$tio%


39/46

A$ti/atio% of ?om&-#m#%t Sy"t#m

• ?om&-#m#%t "y"t#m i" a$ti/at#' )yth# )i%'i%+ of a%ti)o'i#" to for#i+%'#)ri". – I% thi" $a"# it" o/#r a$ti/atio%

• R@?" -a$k ?R7 r#$#&tor – D#$r#a"i%+ th# a#$ti/# r#mo/a- of

$om&-##"


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I+G Patho+#%

• I+G i" th# mo"t &atho+#%i$X)#$au"# it form" i%t#rm#'iat# "i3#'$om&-##" that $a% +#t to th# "ma--

&-a$#" a%' )-o$k th#m.


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LE ?#--

• Th# LE $#-- i" a%#utro&hi- that ha"#%+u-f#' th# a%ti)o'y6$oat#' %u$-#u" ofa%oth#r %#utro&hi-.

• LE $#--" may a&ar i%ro"#tt#" 4h#r# th#r#ar# "#/#ra- %#utro&hi-"/yi%+ for a% i%'i/i'ua-$om&-#m#%t $o/#r#'

&rot#i%.


42/46

O/#r/i#4 of th# &atho+#%#"i" of SLE

Ski% $#--

T $#-- T $#--

@ $#--

AP?

AP?

Defective I)clearance

*"light

Infection

+,ternal (g-elf(g

(b

I)

Target

G

en et i c s u s c e

pt i b i l i t y


43/46

Sym&tom"

• No%6"$i$B – Cati+u#

– W#i+ht -o""

–

Ma-ai"# H +#%#ra--y f##-i%+ i-- – C#/#r

– A%or#ia *o/#r tim#,

– Arthriti"•

12 of &ati#%t" #ri#%$# arthriti$ "ym&tom"• Symm#tri$a-

• A&ar" i% ha%'" 4ri"t" a%' k%##" mai%-y


44/46

Ski% Ma%if#"tatio%"

• Ma-ar or@utt#r9y Ra"h

• Di"$oi' Ra"h

Stimu-at#' )yU -i+ht• Ski%

ma%if#"tatio%"

o%-y a&ar i%:16;12 of -u&u"&ati#%t".


45/46

R#%a- *Ki'%#y, Ma%if#"tatio%"

• 016=12 of a-- -u&u"&ati#%t" #ri#%$#r#%a- '#/#-o&m#%t".

• Mo"t Da%+#rou"B – G-om#ru-o%#&hriti"

4h#r# at -#a"t 012 ofth# +-om#ru-i ha/#$#--u-ar &ro-if#ratio%

• G-om#ru-i $a&i--ary)#'" i% th# ki'%#ythat -t#r th# )-oo'.

•

R#%a- Cai-ur# )#$au"#of G-om#ru-o%#&hriti"i" th# -#a'i%+ $au"# of'#ath amo%+ -u&u"&ati#%t".

Norma-

G-om#ru-o%#&hriti"


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Oth#r Ma%if#"tatio%"

• ?ar'ia$

• ?#%tra- N#r/ou" Sy"t#m

• (#mato-o+i$a-

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