KELAINAN

AUTOIMUN
dr. Evi Nurhayatun, Sp.PD, M.Kes, FINASIM
Ilmu Penyakit Dalam FK UNS/ RS Dr Moewardi Surakarta
 Immune response

menguntungkan Tidak diinginkan

Proteksi terhadap infeksi

Alergi

Autoimun D’
Pengendalian Penolakan Graft
pertumbuhan pre- Respons
kanker imun Eritroblastosis fetalis

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 Failure of the immune system

Innocuous antigen hypersensitivity

IMMUNE SYSTEM

infection immunodeficiency autoimmunity

non-self self
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 FAKTOR YANG BERPERAN DALAM
AUTOIMUN

1) Genetik
2) Kelamin
3) Infeksi
4) Obat
5) Usia

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 overview
 Toleransi imunologi : kemampuan sistem
imunitas tubuh secara efektif membedakan
self/non-self dan untuk menahan diri dari
menyerang diri sendiri.
 Kegagalan respons imun terhadap self antigen
akibat hilangnya toleransi  autoimunitas.

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 PENYAKIT AUTOIMUN
Organ Spesifik
ORGAN
Non Organ Spesifik / sistemik

AUTOIMUN Antibodi
(AIHA, MG, Grave’s, An Pernisiosa)

Kompleks Ag-Ab
MEKANISME (SLE, RA, Goodpasture, Sicca complex,
Demam reuma, skleroderma, ITP)
Seluler
(sklerosis multipel, GBS)
Seluler dan humoral
(IDDM, Tiroiditis Hashimoto)

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PENYAKIT AUTOIMUN TIROID
Regulasi sintesis hormon
tiroid

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a) Hipotiroid  Hashimoto's thyroiditis

Disease model for development of thyroiditis.

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b) Hipertiroid  Graves' disease

Hipertiroidisme
Goiter
Optalmopati
T3 & T4 
TSH 

The mechanism of thyroid dysfunction in Graves' disease.

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 DM tipe-1

a) Autoimunitas Islet sangat terkait dengan risiko DM tipe 1.

b) genotipe HLA DR-DQ  prediktor risiko autoimunitas

Islet &/ DM tipe 1 sejak lahir.

c) Autoantibodi terhadap insulin (GAD65, IA-2, atau ZnT8

prediktor DM tipe 1. Autoantibodi insulin atau GAD65
muncul pertama kali pada usia yang sangat muda.

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Natural history and etiology of type 1 diabetes
(Delli AJ & Lernmark (2010) Endocrinology: adult and pediatric)
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 SLE
− penyakit inflamasi autoimun kronis
− etiologi belum diketahui
− Manifestasi klinis, perjalanan penyakit & prognosis beragam.

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Diagnosis SLE
menggunakan kriteria
ACR revisi 1997

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 ARTHRITIS
Autoimun Overuse
 OA
 RA  RF
 Spondiloartritis
seronegatif (HLA
B27) :
-Ankilosing
-Reiter’s ARTHRITIS
-Psoriatic
-Enteropatic

Infeksi Depository
 Septic  Gout
 Pseudogout
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 Reumatoid Artritis
 Rheumatoid arthritis (RA) : penyakit autoimun sistemik 
inflammatory polyarthritis ( sendi perifer  sendi kecil
tangan/kaki)  erosi & destruksi sendi.
 Male/female =1:2; prevalence increases with age.
 HLA-DRB1, PTPN22, and PADI4.

(From Ballinger A: Kumar & Clark’s essentials of clinical medicine, ed 6, Edinburgh,

2012, Saunders.) 21
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 Autoimmune hemolytic anemia (AIHA)
 AIHA : anemia sekunder akibat kerusakan dini RBCs
disebabkan oleh ikatan autoantibodies &/ complement
terhadap RBCs.
 most common in women <50 yr
 Physical Findings & Clinical Presentation
• Pucat, ikterus.
• Takikardi.
• dyspnea dan lemah.
• intravascular hemolysis  dark urine and back pain.
• hepatomegaly and/or lymphadenopathy  underlying
lymphoproliferative disorder or malignancy; splenomegaly may
indicate hypersplenism as a cause of hemolysis.

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Etiology
 Warm antibody  IgG (idiopathic or associated with
leukemia, lymphoma, thymoma, myeloma, viral
infections, and collagen-vascular disease)
 Cold antibody  IgM and complement (idiopathic; at
times associated with infections, lymphoma, or cold
agglutinin disease)
 Drug induced:
1. Antibody - Rh complex (e.g., methyldopa)
2. Antibody - RBC-drug complex (hapten induced; e.g., penicillin)
3. Antibody-drug-plasma protein complex causes destruction of
RBCs ( e.g., quinidine)

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Terima Kasih