<?xml version="1.0" encoding="UTF-8"?>
<opml version="2.0">
  <head>
    <title>041-02 Autoimmune probability, vascular injury patterns, and safe immune suppression</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Autoimmune probability and safe immune suppression">
      <outline text="Causal coherence and mechanism">
        <outline text="Common features need not share one mechanism"/>
        <outline text="Link features to injury, pathway, time course">
          <outline text="Actively test infection, malignancy, drugs"/>
        </outline>
        <outline text="No single tolerance checkpoint is perfect">
          <outline text="Genes alter several weak checkpoints"/>
          <outline text="Infection supplies costimulation, exposes hidden antigens"/>
        </outline>
        <outline text="Effectors: antibodies, complexes, T cells, cytokines">
          <outline text="Antiphospholipid antibodies promote thrombosis"/>
          <outline text="Naming the mechanism predicts meaningful signals"/>
        </outline>
      </outline>
      <outline text="Antibody testing">
        <outline text="Testing follows a defined clinical question"/>
        <outline text="Antinuclear antibody sensitive, low predictive value">
          <outline text="Repeating rarely measures activity"/>
        </outline>
        <outline text="Antineutrophil antibodies also positive in infection, drugs"/>
        <outline text="Ask what a positive changes, what a negative excludes"/>
        <outline text="Separate activity, classification, prognostic antibodies"/>
      </outline>
      <outline text="Lupus organ surveillance">
        <outline text="Serial pressure, creatinine, protein, sediment">
          <outline text="Dysmorphic cells or casts: glomerular inflammation"/>
        </outline>
        <outline text="Markers must not overrule a stable kidney phenotype"/>
        <outline text="Biopsy shows class, activity, scar, alternatives">
          <outline text="Match treatment to salvageable inflammation"/>
        </outline>
        <outline text="Active sediment progresses despite normal creatinine">
          <outline text="Low muscle mass hides filtration loss"/>
        </outline>
        <outline text="Neuropsychiatric symptoms need sceptical attribution">
          <outline text="A cerebritis label misses infection"/>
        </outline>
      </outline>
      <outline text="Antiphospholipid syndrome">
        <outline text="Events plus persistent laboratory evidence"/>
        <outline text="Lupus anticoagulant paradox">
          <outline text="Prolongs clotting assays yet raises thrombosis"/>
        </outline>
        <outline text="Thrombosis, pregnancy, anticoagulants distort tests"/>
        <outline text="Catastrophic: rapid multiorgan thrombosis">
          <outline text="Anticoagulation, trigger suppression, plasma exchange"/>
        </outline>
      </outline>
      <outline text="Systemic sclerosis">
        <outline text="Vasculopathy, autoimmunity, fibrosis interact"/>
        <outline text="Ulcers, pitting scars, gangrene: structural disease">
          <outline text="Capillaroscopy separates primary Raynaud"/>
        </outline>
        <outline text="Breathlessness has many causes">
          <outline text="Lung disease, pulmonary hypertension, heart, aspiration"/>
        </outline>
        <outline text="Renal crisis: pressure rise, kidney injury, haemolysis">
          <outline text="Continue inhibitor despite creatinine rise"/>
          <outline text="Normal pressure may not exclude crisis if usually low"/>
        </outline>
      </outline>
      <outline text="Sjögren disease and myopathy">
        <outline text="Tear loss damages corneal epithelium"/>
        <outline text="Saliva loss impairs buffering, defence, remineralisation"/>
        <outline text="Objective tests separate gland failure from dryness"/>
        <outline text="Tubular acidosis, purpura signal systemic activity"/>
        <outline text="Myopathy recognised by power, not creatine kinase">
          <outline text="Serial neck, shoulder, hip, swallowing, breathing"/>
        </outline>
        <outline text="Inclusion-body myositis resists immune therapy"/>
        <outline text="Magnetic resonance guides biopsy to active muscle"/>
      </outline>
      <outline text="Vascular patterns and giant-cell arteritis">
        <outline text="Localise by vessel calibre and organ pattern"/>
        <outline text="Large: pulse deficits, bruits, aortic dilatation"/>
        <outline text="Medium: aneurysm, infarction, mononeuritis"/>
        <outline text="Small: purpura, glomerular haematuria, capillaritis">
          <outline text="Framework directs imaging versus biopsy"/>
        </outline>
        <outline text="Giant-cell arteritis: treat at once if vision threatened">
          <outline text="Normal markers reduce but do not eliminate risk"/>
          <outline text="Imaging and biopsy remain useful after treatment"/>
        </outline>
      </outline>
      <outline text="Pulmonary-kidney syndrome">
        <outline text="Alveolar haemorrhage without haemoptysis"/>
        <outline text="Glomerulonephritis: blood, protein, casts"/>
        <outline text="Alternatives: anti-basement-membrane disease, lupus"/>
        <outline text="Plasma exchange for selected mechanisms only"/>
        <outline text="Infection and haemorrhage both cause opacity">
          <outline text="Cultures before and after immunosuppression"/>
        </outline>
        <outline text="Negative antibody does not discard a strong picture"/>
        <outline text="Supportive care does not wait for classification"/>
      </outline>
      <outline text="Safe immune suppression">
        <outline text="Induction stops threat, maintenance limits toxicity"/>
        <outline text="Steroid harm begins immediately"/>
        <outline text="Cyclophosphamide: marrow, bladder, fertility, malignancy"/>
        <outline text="Baseline infection, vaccines, tuberculosis, hepatitis"/>
        <outline text="Prophylaxis: Pneumocystis, viral reactivation"/>
        <outline text="Strongyloides hyperinfection can be fatal"/>
        <outline text="Scheduled monitoring, visible cumulative steroid dose"/>
        <outline text="Contraception and fertility addressed before treatment"/>
      </outline>
      <outline text="Activity versus toxicity">
        <outline text="Fever or opacity: flare, infection, drug toxicity"/>
        <outline text="Escalation without new specimens can harm"/>
        <outline text="Waiting for certainty in organ emergencies harms">
          <outline text="Act in proportion to organ threat"/>
        </outline>
        <outline text="Record mechanism, organ, activity, damage, infection"/>
        <outline text="Non-response is not simply insufficient dose">
          <outline text="Reassess diagnosis, scar, adherence, infection"/>
        </outline>
      </outline>
    </outline>
  </body>
</opml>
