Cutolo Maurizio, Villaggio Barbara, Craviotto Chiara, Pizzorni Carmen, Seriolo Bruno, Sulli Alberto
Research Laboratory and Division of Rheumatology, Department of Internal Medicine, University of Genova, Viale Benedetto XV 6, 16132 Genova, Italy.
Autoimmun Rev. 2002 Oct;1(5):284-9. doi: 10.1016/s1568-9972(02)00064-2.
Sex hormones are implicated in the immune response, with estrogens as enhancers at least of the humoral immunity and androgens and progesterone as natural immune-suppressors. In male rheumatoid arthritis (RA) patients, androgen replacement seems to ameliorate the disease and supports their involvement in the pathophysiology of the disease. The combination of androgens with cyclosporin A or methotrexate has been found to potentiate the apoptosis of monocytic inflammatory cells as well as to reduce the cell growth at least in vitro. Considerable interest has been devoted in the last years as to whether the use of oral contraceptive pills (OCs) may have a protective effect on the risk of RA. The results of many controlled studies have been found contradictory. At the present time, no consensus has been achieved regarding OCs administration and its relationship to the prevention or development of RA. In addition, an association of estrogen receptor gene polymorphism with age at onset of RA has been observed and might further explain inter-individual clinical and therapeutical-response variations. Local increased estrogen concentrations and decreased androgen levels have been observed in RA synovial fluids and seem to play a more important role in the immune/inflammatory local response.
性激素与免疫反应有关，雌激素至少是体液免疫的增强剂，而雄激素和孕酮是天然的免疫抑制剂。在男性类风湿性关节炎（RA）患者中，雄激素替代疗法似乎能改善病情，并支持其参与疾病的病理生理过程。已发现雄激素与环孢素A或甲氨蝶呤联合使用可增强单核细胞炎性细胞的凋亡，并至少在体外减少细胞生长。在过去几年中，人们对口服避孕药（OCs）是否可能对RA风险具有保护作用给予了相当大的关注。许多对照研究的结果相互矛盾。目前，关于OCs的使用及其与RA预防或发展的关系尚未达成共识。此外，已观察到雌激素受体基因多态性与RA发病年龄之间的关联，这可能进一步解释个体间临床和治疗反应的差异。在RA滑液中观察到局部雌激素浓度升高和雄激素水平降低，它们似乎在局部免疫/炎症反应中起更重要的作用。
