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IMF-041-01-0001-en	Why can an autoantibody result not substitute for clinical reasoning in suspected autoimmune disease?	Diagnosis rests on phenotype and objective organ involvement, and similar syndromes arise from infection, malignancy, drugs or inherited immune dysregulation; autoantibodies only modify probability.	Integrated Medical Foundations; chapter 41, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 67341772d77b36727d094f065b4e11eb55669a2f97956ed7d973330fa01ddd97; editorial review pending	imf lang::en chapter::041 module::041-01 review::pending
IMF-041-01-0002-en	Why is autoimmune treatment framed as a balance rather than as maximal suppression?	Suppressing damaging immunity carries risks of infection, malignancy, metabolic toxicity, and loss of vaccine response that must be weighed against its benefit.	Integrated Medical Foundations; chapter 41, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 67341772d77b36727d094f065b4e11eb55669a2f97956ed7d973330fa01ddd97; editorial review pending	imf lang::en chapter::041 module::041-01 review::pending
IMF-041-01-0003-en	How do central and peripheral tolerance differ in the way they control self-reactive lymphocytes?	Central tolerance deletes or edits strongly self-reactive lymphocytes during development; peripheral tolerance restrains escaped cells through anergy, regulatory T cells, inhibitory receptors, antigen sequestration, and absent costimulation.	Integrated Medical Foundations; chapter 41, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 67341772d77b36727d094f065b4e11eb55669a2f97956ed7d973330fa01ddd97; editorial review pending	imf lang::en chapter::041 module::041-01 review::pending
IMF-041-01-0004-en	Why do most people exposed to triggers such as infection, ultraviolet radiation or smoking not develop autoimmune disease?	Autoimmunity reflects an interaction among inherited risk, immune history, sex and age, environment, and chance, so a trigger alone is not sufficient.	Integrated Medical Foundations; chapter 41, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 67341772d77b36727d094f065b4e11eb55669a2f97956ed7d973330fa01ddd97; editorial review pending	imf lang::en chapter::041 module::041-01 review::pending
IMF-041-01-0005-en	By what processes can an initial autoimmune response expand beyond its first target?	Molecular mimicry, epitope spreading, bystander activation, and modified self proteins can each broaden the response.	Integrated Medical Foundations; chapter 41, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 67341772d77b36727d094f065b4e11eb55669a2f97956ed7d973330fa01ddd97; editorial review pending	imf lang::en chapter::041 module::041-01 review::pending
IMF-041-01-0006-en	Why should a clinician not assume a single damage mechanism in an autoimmune patient?	Injury can come from receptor-blocking or stimulating antibodies, immune complexes, complement, cytotoxic T cells, macrophages, granulomas, thrombosis or fibrosis, and several can operate at once.	Integrated Medical Foundations; chapter 41, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 67341772d77b36727d094f065b4e11eb55669a2f97956ed7d973330fa01ddd97; editorial review pending	imf lang::en chapter::041 module::041-01 review::pending
IMF-041-01-0007-en	Why is a positive antinuclear antibody weak evidence on its own, and when should it be tested?	It occurs in healthy people, infection, drugs, cancer and relatives as well as connective-tissue disease, so it is tested only when pretest probability justifies it; titre and pattern guide follow-up but do not diagnose.	Integrated Medical Foundations; chapter 41, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 67341772d77b36727d094f065b4e11eb55669a2f97956ed7d973330fa01ddd97; editorial review pending	imf lang::en chapter::041 module::041-01 review::pending
IMF-041-01-0008-en	How do anti-double-stranded-DNA and anti-Ro antibodies differ in what they tell the clinician?	Anti-double-stranded-DNA titres, together with complement, may track lupus kidney activity in some patients, whereas anti-Ro antibodies carry pregnancy implications.	Integrated Medical Foundations; chapter 41, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 67341772d77b36727d094f065b4e11eb55669a2f97956ed7d973330fa01ddd97; editorial review pending	imf lang::en chapter::041 module::041-01 review::pending
IMF-041-01-0009-en	Why are inflammatory markers a poor guide to serious autoimmune organ disease, and what gives stronger evidence of damage?	They are nonspecific and can be normal during serious organ disease; complement consumption, blood counts, urine sediment, protein excretion, kidney function, imaging and biopsy often show damage better.	Integrated Medical Foundations; chapter 41, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 67341772d77b36727d094f065b4e11eb55669a2f97956ed7d973330fa01ddd97; editorial review pending	imf lang::en chapter::041 module::041-01 review::pending
IMF-041-01-0010-en	Why does lupus require regular blood pressure, creatinine, urine sediment and protein measurement even without symptoms?	Lupus kidney involvement ranges from mild urinary abnormalities to proliferative or membranous glomerular disease and can be silent; regular measurement detects it, and biopsy classifies it when treatment depends on it.	Integrated Medical Foundations; chapter 41, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 67341772d77b36727d094f065b4e11eb55669a2f97956ed7d973330fa01ddd97; editorial review pending	imf lang::en chapter::041 module::041-01 review::pending
IMF-041-01-0011-en	Why must neurological symptoms in a patient with lupus not be attributed to lupus without further evaluation?	Infection, thrombosis, metabolic disturbance, drugs and primary psychiatric disease can produce similar symptoms and must be carefully excluded.	Integrated Medical Foundations; chapter 41, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 67341772d77b36727d094f065b4e11eb55669a2f97956ed7d973330fa01ddd97; editorial review pending	imf lang::en chapter::041 module::041-01 review::pending
IMF-041-01-0012-en	Why is hydroxychloroquine used in most suitable lupus patients, and what does its use require?	It reduces flares and improves outcomes, but it requires weight-based dosing and retinal surveillance.	Integrated Medical Foundations; chapter 41, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 67341772d77b36727d094f065b4e11eb55669a2f97956ed7d973330fa01ddd97; editorial review pending	imf lang::en chapter::041 module::041-01 review::pending
IMF-041-01-0013-en	Why do antiphospholipid antibodies alone not establish antiphospholipid syndrome, and why does test timing matter?	The syndrome needs persistently positive defined antibodies plus thrombosis or characteristic pregnancy morbidity, and anticoagulants and acute illness affect the tests, so timing and repetition matter.	Integrated Medical Foundations; chapter 41, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 67341772d77b36727d094f065b4e11eb55669a2f97956ed7d973330fa01ddd97; editorial review pending	imf lang::en chapter::041 module::041-01 review::pending
IMF-041-01-0014-en	What distinguishes catastrophic antiphospholipid syndrome, and how is it managed?	It causes rapid multiorgan small-vessel thrombosis and requires urgent anticoagulation, immunomodulation, and treatment of the trigger.	Integrated Medical Foundations; chapter 41, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 67341772d77b36727d094f065b4e11eb55669a2f97956ed7d973330fa01ddd97; editorial review pending	imf lang::en chapter::041 module::041-01 review::pending
IMF-041-01-0015-en	How does scleroderma renal crisis present, how is it treated, and which drug exposure raises its risk?	It causes abrupt hypertension and kidney injury and is treated urgently with angiotensin-converting-enzyme inhibition; high-dose glucocorticoids increase crisis risk.	Integrated Medical Foundations; chapter 41, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 67341772d77b36727d094f065b4e11eb55669a2f97956ed7d973330fa01ddd97; editorial review pending	imf lang::en chapter::041 module::041-01 review::pending
IMF-041-01-0016-en	Why do patients with systemic sclerosis need systematic lung and pulmonary-vessel screening whatever their cutaneous pattern?	Interstitial lung disease and pulmonary arterial hypertension are major causes of death, and both limited and diffuse cutaneous patterns can affect the lung and pulmonary vessels.	Integrated Medical Foundations; chapter 41, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 67341772d77b36727d094f065b4e11eb55669a2f97956ed7d973330fa01ddd97; editorial review pending	imf lang::en chapter::041 module::041-01 review::pending
IMF-041-01-0017-en	Why is dryness alone insufficient to diagnose Sjögren disease, and how is it assessed?	Medicines, dehydration, diabetes, radiation, hepatitis, human immunodeficiency virus and ageing can mimic dryness, so symptoms are combined with tear or salivary function, ocular staining, antibodies, ultrasound or biopsy.	Integrated Medical Foundations; chapter 41, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 67341772d77b36727d094f065b4e11eb55669a2f97956ed7d973330fa01ddd97; editorial review pending	imf lang::en chapter::041 module::041-01 review::pending
IMF-041-01-0018-en	In Sjögren disease, which findings should shift attention from dryness toward lymphoma?	Persistent gland enlargement, enlarged lymph nodes, purpura, low complement, or cryoglobulins raise lymphoma concern.	Integrated Medical Foundations; chapter 41, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 67341772d77b36727d094f065b4e11eb55669a2f97956ed7d973330fa01ddd97; editorial review pending	imf lang::en chapter::041 module::041-01 review::pending
IMF-041-01-0019-en	Why is it important to distinguish inclusion-body myositis from other immune-mediated myopathies?	It often affects finger flexors and quadriceps asymmetrically and responds poorly to conventional immunosuppression, so it should not be treated as an immune-responsive myopathy.	Integrated Medical Foundations; chapter 41, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 67341772d77b36727d094f065b4e11eb55669a2f97956ed7d973330fa01ddd97; editorial review pending	imf lang::en chapter::041 module::041-01 review::pending
IMF-041-01-0020-en	Why must infection be excluded before immunosuppression for suspected vasculitis?	Infection, drugs, malignancy, emboli, cholesterol, thrombosis and vasospasm can mimic vasculitis, and immunosuppression before excluding infection can be catastrophic.	Integrated Medical Foundations; chapter 41, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 67341772d77b36727d094f065b4e11eb55669a2f97956ed7d973330fa01ddd97; editorial review pending	imf lang::en chapter::041 module::041-01 review::pending
IMF-041-01-0021-en	In giant-cell arteritis with threatened vision, why are glucocorticoids given before definitive imaging or biopsy?	Threatened vision requires immediate treatment, so glucocorticoids are started at once rather than after definitive imaging or biopsy.	Integrated Medical Foundations; chapter 41, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 67341772d77b36727d094f065b4e11eb55669a2f97956ed7d973330fa01ddd97; editorial review pending	imf lang::en chapter::041 module::041-01 review::pending
IMF-041-01-0022-en	How does kidney involvement differ between medium-vessel and small-vessel vasculitis?	Medium-vessel disease causes kidney ischaemia without primary glomerulonephritis, whereas small-vessel vasculitis produces glomerulonephritis.	Integrated Medical Foundations; chapter 41, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 67341772d77b36727d094f065b4e11eb55669a2f97956ed7d973330fa01ddd97; editorial review pending	imf lang::en chapter::041 module::041-01 review::pending
IMF-041-01-0023-en	Why can pulmonary-kidney syndrome be missed if clinicians wait for haemoptysis?	Haemoptysis can be absent; alveolar haemorrhage may show only as breathlessness, falling haemoglobin and diffuse lung opacities, alongside blood and protein in urine and rapid kidney loss.	Integrated Medical Foundations; chapter 41, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 67341772d77b36727d094f065b4e11eb55669a2f97956ed7d973330fa01ddd97; editorial review pending	imf lang::en chapter::041 module::041-01 review::pending
IMF-041-01-0024-en	A patient on immunosuppression develops fever and a new lung opacity. Why should immunosuppression not be escalated reflexively?	The change may be infection, drug toxicity, thrombotic microangiopathy or flare, so cultures and targeted diagnostics come first when the patient is stable enough.	Integrated Medical Foundations; chapter 41, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 67341772d77b36727d094f065b4e11eb55669a2f97956ed7d973330fa01ddd97; editorial review pending	imf lang::en chapter::041 module::041-01 review::pending