Da Silva J A, Hall G M
Baillieres Clin Rheumatol. 1992 Feb;6(1):196-219.
Disease patterns in RA vary between the sexes; the condition is more commonly seen in women, who exhibit a more aggressive disease and a poorer long-term outcome. Men, however, are more likely than women to die from extra-articular complications of rheumatoid disease. This chapter discusses the outcome and mortality studies that substantiate these conclusions and then examines the possible mechanisms that may account for them, including the HLA system, seropositivity, compliance, response to therapy and pain threshold. In particular, sex and sex hormones emerge as independent risk factors in rheumatoid disease. The epidemiological evidence points towards a peak age of onset of RA at the time of the menopause in women and towards later in life in men. Premenopausal women may fare better than postmenopausal women with RA. The possible protective effects of the oral contraceptive pill and the dramatic amelioration with pregnancy are well documented. In vivo and in vitro studies have demonstrated that sex hormones interfere with a number of the putative processes involved in the pathogenesis of RA, including immunoregulation, interaction with inflammatory mediators and the cytokine system, and direct effects on cartilage itself. All these observations point towards the importance of gonadal hormones. However, trials on the potential therapeutic use of sex hormones in RA are limited and, as yet, disappointing. Further work is necessary to determine whether the roles of sex hormones are as central protagonists or just supporting cast in the complex arena of rheumatoid disease.
类风湿关节炎（RA）的疾病模式存在性别差异；这种疾病在女性中更为常见，她们表现出更具侵袭性的疾病和更差的长期预后。然而，男性比女性更易死于类风湿疾病的关节外并发症。本章讨论了证实这些结论的结局和死亡率研究，然后探讨了可能解释这些差异的机制，包括人类白细胞抗原（HLA）系统、血清阳性、依从性、对治疗的反应和疼痛阈值。特别是，性别和性激素已成为类风湿疾病中的独立危险因素。流行病学证据表明，女性RA发病的高峰年龄在绝经时，而男性则在生命后期。绝经前患RA的女性可能比绝经后女性病情更好。口服避孕药的可能保护作用以及妊娠带来的显著改善已有充分记录。体内和体外研究表明，性激素会干扰RA发病机制中涉及的许多假定过程，包括免疫调节、与炎症介质和细胞因子系统的相互作用，以及对软骨本身的直接影响。所有这些观察结果都表明性腺激素的重要性。然而，关于性激素在RA中潜在治疗用途的试验有限，且目前令人失望。需要进一步开展工作，以确定性激素在类风湿疾病这个复杂领域中是核心主角还是仅仅是配角。
