When I first started as a rheumatology nurse, I got my hands on anything I could to help me learn about things that would help me to better serve my patients. Books, journal articles, you name it and I devoured it. Some things were easier to learn than others, and the immune system was definitely not one of them! But by breaking the immune system down into small pieces and relating the actions of the various components into tangible analogies, I found I was able to retain and then relate important concepts to my patients.
There are handy tables within this issue of Rheumatology Nurse Practice that offer some advice on how to think about and explain many of the major players in the immune systems, but I have some additional tricks that worked for me.
We all know that everyone has white blood cells (WBCs). In normal immune systems, there is a feedback loop that tells the WBCs when to react and then when to turn off the reaction. In individuals with an autoimmune disorder, this feedback loop is broken.
Our WBCs can be further divided into T cells and B cells, which can both be further broken down as well. Patients with RA do not possess the shutoff button to turn down T cell activity. Regulatory T cells (the fireman and police) are there to direct traffic into and out of the joint space, but in patients with RA, they are on an extended coffee break, allowing way too many inflammatory proteins into the joint space.
Memory T cells are supposed to differentiate the good guys from the bad guys (pathogens), but they get lazy in patients with autoimmune disease and allow bad guys in to attack the body’s tissues. In normal immune systems, cytoclastic T cells act like garbage collectors by removing damaged or destroyed cells. In patients with RA, these cells are also dysfunctional and allow the joint space to get swollen and boggy with cellular activity. This increased cellular debris then starts to wear away at the cartilage within the joint space, create boney erosions and leading to a thickening of the wall or lining of the joint space.
Helper T cells are the paramedics of the immune system, the first responders to an immune “alarm.” Once in the joint space, these new-on-the-job helper T-cells secrete pro-inflammatory mediators called cytokines to fill the joint space.
A cytokine is a hormone-like protein that is constantly in communication with other hormone-like proteins. When I think about cytokines, I think of my teenage daughters. They are social media experts, using Facebook/Instagram/Snapchat to bring other cytokines such as various interleukins and tumor necrosis factor into the drama of joint destruction.
Our WBC’s also can differentiate into B cells, which act in a similar fashion as T cells by identifying foreign invaders and proteins, and protecting the body from pathogens.
Of course, there are other players that impact the performance of the immune system, such as macrophages, and there are further mental tricks you can develop to help you remember how all of these systems function and work together. What worked for me may not work for you, but everyone should have their own way to remember and convey important information to our patients in a manner they understand.
Iris Zink, MSN, NP, is a nurse practitioner at
the Beals Institute in Lansing, Michigan, and the President-Elect of the Rheumatology Nurses Society.