Sex hormones, immune disorders, and inflammatory rheumatic diseases

Danas je sve više podataka koji potvrđuju da su spolni hormoni uključeni u imunološki odgovor te da androgeni i estrogeni moduliraju pojavnost i progresiju autoimunih reumatskih bolesti. Drži se da estrogeni stimuliraju staničnu proliferaciju i humoralni imunološki odgovor dok androgeni iskazuju supresivni učinak na humoralni i stanični imunološki odgovor. Autoimune bolesti česte su u žena, naročito u generativnoj dobi. Sistemski eritemski lupus najbolji je primjer autoimune bolesti ovisne o estrogenima. Poznato je da su u patogenezu bolesti uključeni estrogeni i androgeni te da su i egzogeni i endogeni estrogeni snažni pokretači stvaranja citokina i aktivnosti bolesti. Pojedina fiziološka stanja, lijekovi i kronični stres mogu mijenjati razinu spolnih hormona. Niske razine gonadalnih androgena nađene su u tkivnim tekućinama muškaraca i žena oboljelih od reumatoidnog artritisa, što upućuje na to da hipoandrogenemija sudjeluje u patogenezi ove bolesti. Stav o primjeni hormonalne nadomjesne terapije ili kontraceptiva u reumatskim bolestima danas je promijenjen. U većini reumatskih bolesti, uključujući reumatoidni artritis, ova terapija nije zabranjena. No, još uvijek postoje dvojbe u sistemskom lupusu. Novi stavovi drže da kontraceptivi nisu kontraindicirani u bolesnica s inaktivnim ili stabilnim aktivnim sistemskim lupusom, osim u onih koje imaju pozitivna antifosfolipidna protutijela.It is a well-documented fact that sex hormones are implicated in the immune response and that androgens and estrogens modulate susceptibility and progression of autoimmune rheumatic diseases. Estrogens are considered to stimulate cell proliferation and humoral immune responses while androgens exert suppressive effects on both humoral and cellular immune responses. Autoimmune diseases are common in females, especially during the generative period, the most representative of estrogen-related autoimmune diseases being systemic lupus erythematosus. Estrogens and androgens are involved in the pathogenesis of the disease; both exogenous and endogenous estrogens are strong stimulators of cytokine production and disease activity. Some physiological conditions, as well as some drugs and chronic stress, can modulate hormone levels. Low levels of gonadal androgens have been detected in body fluids of both male and female rheumatoid arthritis patients, supporting the possibility of the pathogenic role for decreased androgen levels. Views on hormone replacement therapy or hormonal contraception in rheumatic diseases have been modified and in most rheumatic diseases, including rheumatoid arthritis, hormones are not prohibited. There are still controversies regarding systemic lupus; the new standpoint being that hormonal contraception is not contraindicated in women with inactive or stable active SLE, except for those with positive antiphospholipid antibodies