Zusammenfassung
In the two prior decades, a multitude of endocrine and nervous system alterations have been described in patients with rheumatoid arthritis. This review demonstrates some important examples: 1. Loss of adrenal antiinflammatory androgens in relation to estrogens, 2. inadequate secretion of adrenal cortisol in relation to systemic inflammation, 3. rapid degradation of androgens in the inflamed ...
Zusammenfassung
In the two prior decades, a multitude of endocrine and nervous system alterations have been described in patients with rheumatoid arthritis. This review demonstrates some important examples: 1. Loss of adrenal antiinflammatory androgens in relation to estrogens, 2. inadequate secretion of adrenal cortisol in relation to systemic inflammation, 3. rapid degradation of androgens in the inflamed synovial microenvironment, 4. high levels of anti-apoptotic 16alpha-hydroxylated estrogens in inflamed synovium, 5. increased cortisol degradation in inflamed synovial tissue, 6. decreased reactivity of the hypothalamic-pituitary-adrenal axis in stressful situations, 7. loss of anti inflammatory sympathetic nerve fibres in relation to proinflammatory sensory nerve fibres in inflamed synovium, 8. increased systemic sympathetic tone, and 9. psychological alterations with chronic fatigue and symptoms of depression due to elevated circulating cytokines. Understanding these neuroendocrine alterations helps to sort out the complex pathophysiological puzzle of rheumatoid arthritis. In addition, comprehension of neuroendocrine aberrations triggers research into novel therapeutic targets for the treatment of patients with rheumatoid arthritis.
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