Learning objectives
Course aims:
At the end of this integrated Course students should:
- have understood the fundamental principles of immunological pathogenesis of diseases
- be able to apply immunological knowledge to diagnose specific clinical conditions
- have learnt the classification of the rheumatic diseases and the main manifestations of rheumatic disorders
- have acquired basic knowledge of targeted pharmacological treatment of autoimmune diseases
- have developed clinical reasoning and problem-solving skills in clinical immunology and rheumatology
Course unit content
This integrated course will consist of two parts. The first part will cover aspects of clinical immunology, including congenital and acquired immune deficiencies, immunological aspets of sepsis and senescence, autoinflammatory disorders, and the main immunological aspects of selected diseases in several branches of internal medicine.
The second part will deliver a detailed description of the pathogenesis and clinical aspects of the main rheumatological diseases. with an emphasis on their clinical impact
Full programme
Part 1 – Clinical Immunology (2 CFU – 20 hours)
Lesson 1 (3 hours)
- Course description and aims
- Brief recap of basic immunology: innate and adaptive immune response, involved cell types, cytokines and chemokines, the complement system
- Types of hypersensitivity reactions
Lesson 2 (3 hours)
- The host response to pathogens during sepsis: PAMPs and DAMPs, role of pattern-recognizing receptors, role of T cell subsets, the cytokine storm, role of cell metabolism reprogramming, role of precision medicine in diagnostics and therapy
- Immune system derangement of senescence: older age and immune cell generation, T-cell population homeostasis, cellular defects in immune aging
- Clinical consequences of immune aging—immunodeficiency, autoimmunity, and accelerated degenerative diseases
Lesson 3 (3 hours)
Primary immunodeficiencies:
- Primary antibody deficiencies: General clinical characteristics. Common variable immunodeficiency and common variable immunodeficiency-like disorders
- Primary T cell deficiencies: General clinical characteristics. Severe combined immune deficiencies vs combined immune deficiencies, differential clinical characteristics.
Systemic disorders of immune regulation:
- Primary and secondary forms of hemophagocytic lymphohistiocytosis. The macrophage activation syndrome
- Autoinflammatory disorders: Familial mediterranean fever
- Autoantibody-mediated phenocopies of primary immunodeficiency diseases: pulmonary alveolar proteinosis and chronic mucocutaneous candidiasis
Lesson 4 (3 hours)
- Primary dysregulation of mast cell function. Primary mast cell disorders: cutaneous and systemic mastocytosis.
- Systemic disorders involving eosinophils: hypereosinophylic syndromes, sarcoidosis
- Drug hypersensitivity: clinical subtypes and characteristics
Lesson 5 (3 hours)
Organ specific immune diseases 1:
- Immune-mediated hemolytic anemias: classification, immunopathogenesis, diagnosis and principles of treatment
- Primary, secondary and drug induced immune-mediated neutropenia: classification, immunopathogenesis, diagnosis and principles of treatment
- Immune-mediated thrombocytopenia: classification, immunopathogenesis, diagnosis and principles of treatment
Lesson 5 (3 hours)
Organ specific immune diseases 2:
- Type I diabetes: immunopathogenesis and pathological characteristics
- Chronic lymphocytic thyroiditis (Hashimoto thyroiditis) and Graves disease: immunopathogenesis and pathological characteristics
- Autoimmune adrenalitis and Addison disease: immunopathogenesis and pathological characteristics
Lesson 6 (3 hours)
Organ specific immune diseases 3:
- Autoimmune hepatitis: classification, immunopathogenesis, diagnosis and principles of treatment
- Primary biliary cholangitis: immunopathogenesis, diagnosis and principles of treatment
- Primary sclerosing cholangitis: immunopathogenesis, diagnosis and principles of treatment
- IgG4-mediated autoimmune pancreatitis: immunopathogenesis, diagnosis and principles of treatment
Lesson 7 (2 hours)
Organ specific immune diseases 4:
- Hypersensitivity pneumonitis: classification, immunopathogenesis, diagnosis and principles of treatment
- Autoimmune myocarditis: classification, immunopathogenesis, diagnosis and principles of treatment
- Atrophic gastritis/Pernicious anemia: immunopathogenesis, diagnosis and principles of treatment
Final Quiz Part 1
Part 1 – Rheumatology (3 CFU – 30 hours)
Lesson 1 (3 hours): classification of rheumatic diseases, definition and interpretation of clinical and laboratory parameters
- Classification and definition of rheumatic diseases
- Pain, definition, physiopathology and clinical pictures.
- Role and significance of autoimmunity and laboratory tests
- Physical examination of patient with rheumatic diseases
- Analysis and interpretation of synovial fluid
Lesson 2 (3 hours): Non-inflammatory rheumatic diseases
- Osteoarthritis, pathogenesis, diagnosis, clinical and radiologic pictures, treatment
- Fibromyalgia, pathogenesis, diagnosis, clinical picture, treatment
- Bone diseases:
o Osteoporosis, diagnosis, clinical picture, treatment
o Osteonecrosis and complex regional pain syndrome, diagnosis, clinical picture, treatment
o Paget’s disease, diagnosis, clinical picture, treatment
Lesson 3 (3 hours): Chronic inflammatory arthritis:
- Rheumatoid arthritis, pathogenesis, diagnosis, clinical and radiologic pictures, treatment
- Extra-articular manifestations of rheumatoid arthritis
Lesson 4 (3 hours): Seronegative spondylarthritis
- Seronegative spondylarthritis: ankylosing spondylitis, entero-arthritis, non-radiographic spondylarthritis, pathogenesis, diagnosis, clinical and radiologic pictures, treatment
- Psoriatic arthritis, pathogenesis, diagnosis, clinical and radiologic pictures, treatment
Lesson 4 (3 hours): Acute arthritis
- Gout, pathogenesis, diagnosis, clinical picture, treatment
- Chondrocalcinosis e microcrystalline arthropathies, pathogenesis, diagnosis, clinical and radiologic pictures, treatment
- Reactive and infectious arthritis, diagnosis, clinical picture, treatment
Lesson 5 (3 hours): Systemic lupus erythematosus and related disorders
Systemic lupus erythematosus, diagnosis, clinical picture, treatment
Anti-phospholipid antibody syndrome, diagnosis, clinical picture, treatment
Mixed connective tissue disease
Undifferentiated connective tissue disease
Lesson 6 (3 hours): Other connective tissue diseases
- Systemic sclerosis, diagnosis, clinical picture, treatment
- Raynaud’s phenomenon and capillaroscopy
Lesson 7 (3 hours): Sjogren’s syndrome and inflammatory idiopathic myopathies
- Sjogren’s syndrome, diagnosis, clinical picture, treatment
- Inflammatory idiopathic myopathies: dermatomyositis, polymyositis, anti-synthetase antibodies syndrome, diagnosis, clinical picture, treatment
Lesson 8 (3 hours): Large and medium vessel vasculitis
- Giant cell arteritis and polymyalgia rheumatica, diagnosis, clinical picture, treatment
- Takayasu’s arteritis, diagnosis, clinical picture, treatment
- Polyarteritis nodosa, diagnosis, clinical picture, treatment
Lesson 9 (3 hours): Small vessel vasculitis (ANCA associated vasculitis)
- ANCA associated vasculitis: granulomatosis with polyangiitis, micro-polyangiitis, eosinophilic granulomatosis with polyangiitis, diagnosis, clinical picture, treatment
Lesson 10 (2 hours): Other small vessel vasculitis and Bechet’s disease
- Cryoglobulinaemic vasculitis, diagnosis, clinical picture, treatment
- IgA vasculitis (Henoch-Schoenlein’s vasculitis), diagnosis, clinical picture, treatment
- Behcet’s disease, diagnosis, clinical picture, treatment
Final Quiz Part 2 (1 hour)
Bibliography
Harrison’s Principles of Internal Medicine (Loscalzo, Fauci, Kasper, Hauser, Longo, Jameson Eds.), 21st Edition, McGraw-Hill 2022
UpToDate, Wolters Kluver, accessible for free through the link: http://www.uptodate.com from computers connected to the web network of the University of Parma
Teaching methods
Lectures and clinical examples
Assessment methods and criteria
Final Exam:
The final exam will be performed by the administration of a multiple-choice test, consisting of 50 questions (20 questions covering topics of the section of Clinical Immunology and 30 questions covering topics of the section of Rheumatology) with 4 possible answers. Correct answers will receive a score of 1. Wrong answers will receive a score of -0.5 and unanswered questions will receive a score of 0. A minimum of 70% of success, corresponding to 35 correct answers will be required to pass the exam.
Thirty-five correct answers will correspond to a final score of 18/30. The number of correct answers exceeding the minimum of 35 will be scaled to progressively increasing scores up to a maximum of 30/30 cum laude, corresponding to 50 correct answers.
A time interval of 75 minutes will be allowed to answer 50 questions. Supplemental time will be allowed only upon previous exhibition of a formal certification of special needs.
The use of textbooks or written notes, as well the use of cellular phones or tablets will not be allowed during the exam, pending the invalidation of the test.
Simulation tests will be administered in the last hour of the last lesson at the end of each section of the integrated Course.
