CAN OESTROGENS BE USED AS ADJUVANT THERAPY IN FEMALE PATIENTS WITH RHEUMATOID ARTHRITIS?

In this review the arguments for a relation between female sex hormones and rheumatoid arthritis are discussed. Clinical evidence includes a relation between disease activity and menstrual cycle and a clear decrease in disease activity during pregnancy. A protective effect of oral contraceptives on the develop-ment of rheumatoid arthritis is claimed. There are conflicting data with regard to the plasma levels of sex hormones in women with rheumatoid arthritis. In vitro gonadal hormones suppress T-lymphocyte pro-liferation, while B-lymphocyte differentiation is enchanced by oestrogens and diminished by testosterone. Some pilot studies suggest that oestrogens may ameliorate disease activity in women with active rheu-matoid arthritis. Presently we are conducting a randomized, double-blind trial comparing oestrogens with placebo as adjuvant therapy in women with rheumatoid arthritis. IMMUNE reactivity is stronger in females than in males. In both experimental animals and in man there is a preponderance of autoimmune dis-eases in females, compared with males. Sex steroids are believed to influence the immune system although the precise mechanism is unknown. It is suggested that gonadal steroids may mediate their effects on the immune system directly on lymphocytes and perhaps also indirectly via the thymus-hypothalamus-pitui-tary-gonadal (THPG) axis. This field of research has been named immunoendocrinol-ogy, and several reviews were recently published [1-5]