A Friend’s Trouble

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About This Module 

Topics: Human health, epidemiology, immune system and immune responses, autoimmune diseases

Grade levels: 9-12

Overview  

Students investigate a friend’s problem.  When one of their friends is diagnosed with a debilitating autoimmune disease, they want to help!  They need to find out everything they can to support her through the illness. What exactly is an autoimmune disease? How did she get it? What kind of treatment can she have to fight it? Is there a cure? What can they do to help her deal with it?

Learning Objectives  

To better understand the body’s immune system responses and autoimmune disorders, the student should be able to:

  • Explain the body’s immune system functions and responses using scientific terminology, including immunity, immunological memory, chemotaxins, antibody, immunological specificity, and DAMPs/PAMPS.
  • Describe what an autoimmune disorder is and how it can affect the body.
  • List examples of autoimmune diseases, their symptoms and the main organs and tissues they affect.
  • Explain how juvenile rheumatoid arthritis affects the body.
  • Develop strategies that may help a patient cope with juvenile rheumatoid arthritis.
Standards  

Next Generation Science Standards

Standards Aligned to PBL Modules

Scenario (with possible answers)  

 A Friend’s Trouble

Why is Emily so quiet lately? Walking to the cafeteria table you see her, and yet again, she’s just High school girl playing a guitar in a school bandsitting there, staring at her lunch tray or out the window. What is going on, you ask yourself, for the hundredth time?

This is NOT like Emily.  Your best friend is always talking, laughing, joking around, or running off to her next soccer practice, band practice, or art class.  You’ve never known her to be like this.

You have asked her what was wrong so many times!  She says “nothing” and when you told her you didn’t believe it, she said she was just tired.  Nope, you’re not believing that, either. You know something’s wrong.

Three high school girls at soccer practiceNow that you think of it, she has missed a few soccer practices.  She seemed distracted in jazz band practice and since you sit near her as she plays her guitar, you know she hasn’t really been playing well much of the time. That’s not like her at all.

You are determined to get to the bottom of it!

You don’t have to wait long. You were planning on talking to her about it again that evening and when you found her crying in the restroom, you knew it had to be bad.

Emily told you that she had been so tired that her mom insisted she go to the doctor. At the doctor’s appointment, she finally had to admit that she hadn’t been feeling well for a while. She also had to admit to the pain that has had her pretty scared. The doctor did an exam, ordered some tests, and said he would call with the results. When he called, he had ordered more tests—x-rays this time.

Then, last week, the doctor asked her parents to come to the office with Emily to discuss the results of the blood work and x-rays.  The physical exam results had suggested and the test results confirmed that Emily had juvenile rheumatoid arthritis—an autoimmune disease.

You are in shock!  Arthritis?  Your grandma has arthritis; only old people get arthritis, right?

Emily starts to tell you what has been happening with her. She kept it secret so long. She was really scared and hadn’t even told her parents until it got bad. It started when she was playing soccer and it got too painful to run down the field. Next, she started having trouble playing her piano; her fingers were so stiff and sore that she couldn’t even play music she had already learned. Playing her guitar was getting more difficult, too.

Her mom started asking questions when Emily didn’t want to go on their regular walks. The two of them had always enjoyed the exercise and their talks.  Emily was too tired and too achy for that kind of walking now.

By this time, you were afraid to find out about juvenile rheumatoid arthritis. Emily explained that juvenile rheumatoid arthritis was not the more common type of joint stiffness and pain that elderly people get. It was an autoimmune disease.

Emily said she was embarrassed and didn’t know what her friends and the people at school were going to think when they heard. She was at a point where she couldn’t hide it anymore. She can’t play soccer when it hurt just to walk. What excuse could she use for quitting the team? Was she going to have to quit the band? Would she have to give up playing the piano? Going for walks? Just today, her hands hurt after holding a paint brush during first period art class. Would she have to drop art?  What would people think? Would they think she had an old people’s disease? Would they think it was catchy?

No wonder Emily was crying.

Three female friends sitting on a bench outsideYou and several of Emily’s friends decide to find out as much as you can about juvenile rheumatoid arthritis.  You want to understand what she has, how she got it, and what treatment she could have to make this more bearable. If you know more about it, you can help Emily through this. You think her life may have to change a little, but that doesn’t mean she has to go through this alone.  And if people at school knew something about what Emily was going through, you are sure that everyone would understand.  Emily wouldn’t have to worry so much! You and Emily’s other friends also think that making the effort to learn all about Emily’s illness will show her how much all of you support her.

Emily and her parents give their permissions to discuss her condition and her progress with students and teachers at the school.

You know there’s a lot to find out and you know it’s serious. What exactly is juvenile rheumatoid arthritis? What is an autoimmune disease? How did Emily get it? What kind of treatment is used to fight it? Is there a cure? How bad can it get?

Obviously, you need to research this condition if you’re going to help Emily.

Your Tasks

  • Decide on a plan to help Emily inform the other students about her condition and make her student life at school easier. Be specific with your ideas.
  • Make a presentation that will provide information about juvenile rheumatoid arthritis, autoimmune diseases, and the plan to help Emily at school.
  • To be able to explain Emily’s condition, you must have a thorough understanding of the immune responses occurring in her body.
  • Be able to explain her condition using correct terminology, including antibody vs autoantibody, immune responses, and autoimmunity.
  • Research juvenile rheumatoid arthritis to prepare for your presentation. You can use any kind of presentation aid available to you, including PowerPoint. (Your teacher may have other requirements.)
  • Be prepared to answer the questions presented in this module.
  • Be prepared to answer the questions from your classmates or teacher as they play the roles of other students or teachers at the school who will be interested in finding out about Emily’s condition and in helping her cope with it.
  • Based on the results of your classroom role-playing intervention, evaluate how effective your plan was in helping students and school personnel understand Emily’s challenges and in helping Emily cope with her illness. What could you have done differently? What else could you do that may help?

Guiding Questions

  1. What is juvenile rheumatoid arthritis?

Juvenile rheumatoid arthritis is an autoimmune disorder that begins before age 16 years. Symptoms vary with the type of juvenile arthritis and also from patient to patient. Not all children with juvenile arthritis have all the same symptoms.

  1. How did Emily “get it”? How do people get autoimmune diseases?

Scientists are not quite sure how people develop autoimmune diseases. Genetics seems to play a large role in determining whether or not someone will “get” an autoimmune disease. If a particular autoimmune disease runs in a family’s genetic make-up, family members seem to be more likely to get the disease. While some diseases are associated with single genes, juvenile arthritis is associated with clusters of genes.

Environmental factors also seem to play a role in autoimmune disease although scientists are less sure about what factors can be triggers. It is probably a combination of genetic and environmental factors which influence whether or not a person will develop an autoimmune disease.

  1. How is the immune system supposed to work? What has gone wrong in Emily?

 Your immune system is supposed to work to protect you from infection and unhealthy cells that may form or enter the body. Using a system of cells, fluids, and organs, your body identifies these harmful cells, such as viruses or bacteria, and seeks to destroy them.

Emily has an autoimmune disease which means that the body does not recognize that some cells are actually body cells.  An autoimmune disease results when the body cannot distinguish between its own cells and foreign cells and starts to attack its own cells.

  1. What other diseases are autoimmune? Name and describe at least three. Are all symptoms of the different autoimmune diseases the same?

Examples of Autoimmune Disease

 

Autoimmune Disease

 

 

Organs/Tissues Affected

 

Symptoms

Autoimmune hepatitis liver Enlarged liver

Yellowing of skin or whites of eyes (jaundice)

Dark urine

Nausea or vomiting

Stomach pain

Fatigue

Diabetes type1 pancreas Extreme thirst

Feeling hungry or tired all the time

Prolonged healing time for sores, injuries

Eye, kidney, nerve, gum, and teeth damage over time

Heart disease over time

Graves’ Disease thyroid (overactive) Irritability

Weight loss

Sweating

Muscle weakness

Bulging eyes

Shaky hands

Hashimoto’s disease thyroid (underactive) Fatigue

Weight gain

Sensitivity to cold

Muscle aches and stiff joints

Constipation

Facial swelling

Weakness

Multiple sclerosis Nerves of the brain and spinal cord

 

(Location of attacks varies with the episode.)

Weakness

Loss of coordination and balance

Muscle spasms

Problems walking

Paralysis

Numbness in arms, legs, hands, and feet

Difficulty beginning to urinate

Constipation

Double vision and vision loss

Hearing loss

Myasthenia gravis Nerves and muscles throughout the body Weakness or paralysis

Drooping head

Difficulty with speech

Double vision

Difficulty swallowing

Rheumatoid arthritis Joints throughout the body Painful, swollen joints usually on both sides of the body

Morning stiffness

Difficulty with movements with limited range of motion

Fatigue

Fever

Weight loss

Lung disease

Anemia

Nodules of tissue under the skin

Systemic lupus erythematosus Joints, skin, heart, kidneys, lungs

(also called lupus)

 

(Symptoms often depend on which body part is affected.)

Weight loss

Chest pain when taking a deep breath

Swollen lymph nodes

Hair loss

Mouth sores

Fatigue

Fever

“butterfly” rash on the face

Headache

Dizziness

Seizure

Memory problems

Symptoms of autoimmune diseases can be very different.  Symptoms of the same autoimmune disease can be different from patient-to-patient.

  1. What are the symptoms of juvenile rheumatoid arthritis?

Painful, swollen joints usually on both sides of the body, morning stiffness, difficulty with movements with limited range of motion, fatigue, fever, weight loss, lung disease, anemia, nodules of tissue under the skin

  1. What kinds of treatment are used?

Usually a combination of strategies is used to relieve pain and swelling and to help maintain movement and strength.

Pain relievers are used to lessen discomfort and other medications include anti-inflammatory drugs, DMARDs (disease-modifying anti-rheumatic drugs, corticosteroids, and other drugs that may show the progress of the disease.

Physical therapy is also used to help keep joints flexible and to maintain muscle tone. Exercise is important to reducing the symptoms and maintaining range of motion.

Sometimes, surgery may be necessary to improve the position of a joint.

  1. Is there a cure?

There is no cure, but remission is possible if the disease is diagnosed and treated promptly. The quality of life can be greatly improved with treatment.

  1. What is the incidence of this type of autoimmune disease?

Epidemiologists study the disease incidence (how often a disease occurs). Rheumatoid arthritis is the third most common type of arthritis, following osteoarthritis and gout.

  1. What kinds of populations or age groups does this disease usually affect?

Cases of rheumatoid arthritis (RA) increase with age in most populations until age 80 when it begins to decrease. Women are more likely to suffer from RA than are men.

Juvenile Idiopathic Arthritis is the most common type of arthritis in children. If affects approximately 300,000 children in the U.S.

  1. What is Emily’s prognosis (the likely outcome of a health condition)?

 With prompt treatment and good medical care, Emily may experience a remission of symptoms from this disease. It is also possible that she may develop significant levels of disability with active disease for long periods of time.

  1. What plan would work best in informing other students and school personnel about Emily’s condition and challenges that result? Do you think your plan would work for most school populations or is your plan specific to your school? How will you determine if your plan is effective?

Answers will vary, but students should develop a solid, multi-faceted approach to the problem. Students should also describe any problems that may occur within their approach and describe how they might solve the problem.

Criteria for evaluation of effectiveness should be submitted with their plan.

Sample Rubric  

Information about constructing and implementing rubrics for problem-based learning strategies can be found in Developing Rubrics in the Teacher Professional Development section.

Extensions  

Invite a health professional with some knowledge of autoimmune diseases to discuss them with your class.  A nurse, a physician assistant, a doctor, or a specialist in the field could describe not only the diseases, but also their career paths.

► Have your students report on one of the other autoimmune diseases discussed in the background support materials. They should include information on organs affected, symptoms, tests, treatments, and prognosis.

► Ask your students if they have a relative or friend with an autoimmune disease and let them describe how it affects their relative or friend. (Be aware of privacy issues and tell them not to mention names.)

Additional Resources  

Additional resources about emerging and re-emerging diseases can be found:

in the Key Resources section in the Pandem Disease Center at http://www.pandemsim.com/pdc/index.php/key-resources/

in the Key Resources section in Resources-Non-infectious Health Conditions

http://www.pandemsim.com/pdc/index.php/resources-non-infectious-health-conditions/

in A Friend’s Trouble module’s Internet Resources: Juvenile Idiopathic Arthritis at http://www.pandemsim.com/pdc/index.php/juvenile-idiopathic-arthritis-internet-resources/