Autoimmunity

Module details

Title

Autoimmunity

Type

Specialist

Module code

SLS120

Credits

10

Requirement

Compulsory

Aim of this module

This module will provide the trainee with knowledge and understanding of the mechanism of autoimmunity. They will understand the clinical presentation and investigation of a range of autoimmune disease. They will become familiar with methods and strategies to investigate autoimmunity and gain experience of the interpretation of patient results in a variety of clinical settings.

Competencies

#	Learning outcome	Competency	Action
# 1	Learning outcome 1	Competency Select appropriate methods for investigation of autoimmune disorders.	Action View
# 2	Learning outcome 1,2	Competency Perform appropriate methods for the investigation of autoimmune disorders, including all of the following: autoimmune serology immunofluorescence Western blotting nephelometry iso-electric focusing agglutination assays Luminex, where available.	Action View
# 3	Learning outcome 3,4	Competency Interpret immunological data in light of clinical details on patients with autoimmune disorders, including at least five of the following: adrenal ANA ANCA-P AND C Crithidia endomysial GBM GPC HEp 2 patterns, including centromere ICA Hu and Yo LKM LM mitochondria ovary pemphigoid pemphigus rheumatoid factor smooth muscle skeletal skin salivary thyroid others.	Action View
# 4	Learning outcome 3	Competency Interpret immunological data in light of clinical details.	Action View
# 5	Learning outcome 3,4	Competency Identify cases requiring urgent intervention and be able to suggest what clinical advice on follow-up and/or further management could be offered.	Action View
# 6	Learning outcome 4	Competency Identify relevant clinical investigations from other disciplines that will impact on the interpretation of the immunological investigation.	Action View

Assessments

You must complete:

• 2 case-based discussion(s)
• 2 of the following DOPS/ OCEs:

Perform immunofluoresence luminex ELISA assay to determine if the patient has IgA anti endomysial autoantibodies	DOPS
Read and interpret the immunofluoresence Luminex ELISA assay to determine if the patient has IgA anti endomysial autoantibodies	DOPS
Perform immunofluoresence luminex ELISA assay to determine if the patient has IgA anti TTg autoantibodies	DOPS
Read and interpret the immunofluoresence luminex ELISA assay to determine if the patient has IgA anti TTG autoantibodies	DOPS
Perform immunofluoresence ELISA Luminex assay to determine if the patient has IgG anti ANA autoantibodies	DOPS
Read and interpret the immunofluoresence ELISA Luminex assay to determine if the patient has IgG anti ANA autoantibodies	DOPS
Perform immunofluoresence ELISA Luminex assay to determine if the patient has IgG anti ANCA autoantibodies	DOPS
Read and interpret the immunofluoresence ELISA Luminex assay to determine if the patient has IgG anti ANCA autoantibodies	DOPS
Perform immunofluoresence ELISA Luminex assay to determine if the patient has IgG autoantibodies to CDLP, and or B2gp1	DOPS
Read and interpret the immunofluoresence ELISA Luminex assay to determine if the patient has autoantibodies to CDLP and or B2GPI	DOPS
Perform relevant assays to assess the presence of cryoglobulins	DOPS
Perform relevant assays to assess the presence of rheumatoid factors	DOPS
Perform the assay to assess the levels of immunoglobulins in patients suspected of autoimmune disease	DOPS
Perform western blots to determine the presence of autoantibodies to suspected autoimmune antigens ie liver autoantigens neuronal antigens other autoantigens	DOPS
Perform the relevant lab assay to assess the levels of anti thyroid eroxidase autoantibodies in patients suspected of autoimmune disease	DOPS
Perform the relevant lab assay to assess the levels of autoantibodies to liver autoantigens or mitochondrial autoantigens or GPC or smooth muscle autoantigens	DOPS
Perform the relevant lab assay to assess the levels of autoantibodies to associated autoantigens associated with ANCA related diseases	DOPS
Perform immunofluoresence ELISA Luminex assay to determine if the patient has IgG anti ENA and or DSDNA autoantibodies	DOPS
Take or observe and report back on a patient history from a patient with a suspected connective tissue disease	OCE
Take or observe and report back on a history taking of a patient with a suspected autoimmune disease such as coleiac primary biliary cirrhosis liver disease thryoid disease	OCE
Observe the discussion between the clinician and patient when the patient is offered immunotherapy for their autoimmune disease and as far as possible describe to the patient the nature of the tests	OCE
Take a patient history where there is suspected autoimmune cytopenias in antibody deficient patients	OCE
Observe the discussion between the clinician and patient when the patient is offered immunosupprssive therapry for their autoimmune disease	OCE
Take or observe and report back on a patient history from a patient with a suspected dermatological autoimmune disease	OCE
Take or observe and report back on a patient history from a patient with a suspected neuromuscular junction autoimmune disease	OCE
Obtain a patient history from a normal volunteer or typical patient referred to your service and present the findings to a colleague or peer	OCE

Learning outcomes

1. Select immunology tests for the diagnosis and management of a range of autoimmune diseases.
2. Perform clinical and laboratory investigation of a range of autoimmune diseases.
3. Interpret and report results of investigation of autoimmune disease in the correct clinical context.
4. Work in partnership with other clinical specialisms in the investigation of autoimmune disease.

Learning outcomes

1. Explain the causes of autoimmune disease.
2. Discuss and justify the strategies and methods to distinguish autoimmunity from autoimmune disease.
3. Explain the role of autoantibodies and autoimmune disease.
4. Explain the role of autoreactive T cells and autoimmune disease.
5. Discuss and justify the investigation and management of autoimmune disease.
6. Describe the design, operation and performance of laboratory techniques for the investigation of autoimmune disease.
7. Describe the partnership between clinical immunology and other clinical specialism in the investigation of autoimmune disease and patient care.

Indicative content

• Spectrum and overlap of autoimmune diseases (multifactorial; genetic factors; hormonal factors; environmental factors)
• Autoreactivity
  • Countering immune regulatory mechanisms
  • Pathogenic effects (autoantibodies; autoreactive cells; immune complexes)
  • Diagnostic tests
• Vasculitis
• Rheumatic and connective tissue diseases
• Endocrine autoimmune diseases
• Liver diseases
• Gastrointestinal diseases
• Renal diseases
• Skin diseases
• Neurological diseases

Activities

• Attend a rheumatology clinic to understand the effect of an autoimmune disease on the quality of life of the patient. Reflect on your discussion and identify key learning points that will influence your future practice.
• Attend a range of outpatient clinics that patients with autoimmune diseases may attend and discuss the role and impact of the multi-professional team in the care of such patients. This may include outpatients and primary care chronic disease management clinics.
• Prepare two to three autoimmune patient cases where the results from immunology investigations have altered in response to treatment or where results of immunology investigations influence diagnosis or management.
• Critically appraise the internal quality control and external quality assessment performance of three different methods used in the investigation of autoimmune disorders.
• Contribute to appropriate immunology teaching programmes.