University of Genova, Italy.
Curr Opin Rheumatol. 2010 May;22(3):257-63. doi: 10.1097/BOR.0b013e328336ec24.
Steroid hormones are deeply involved in the pathophysiology of immune-mediated rheumatic diseases and used for their treatment. Purpose of the review is to update on recent roles and mechanisms of action of important steroid hormones such as glucocorticoids, estrogens, and D hormone (vitamin D) in order to optimize their therapeutical use.
Endogenous glucocorticoids are characterized by a circadian rhythm of production that must be respected in case of exogenous low-dose long-term glucocorticoid replacement therapy of rheumatic diseases. Estrogens are enhancers of the humoral immune response and increase cell proliferation. Therefore, estrogens represent a risk factor for the development of autoimmunity and their therapeutical use must be avoided in patients with active immune-mediated diseases. Vitamin D, as synthesized in the skin from cholesterol, is a real steroid hormone (D hormone). The immunosuppressive activities of D hormone are reduced in chronic rheumatic diseases, as low plasma levels of the hormone are evident and justify its therapeutical use.
The optimization of the therapeutical use of steroid hormones such as glucocorticoids, estrogens or D hormone is now possible following recent basic and clinical research achievements.
甾体激素在免疫介导的风湿性疾病的病理生理学中起着重要作用，并被用于治疗。本综述的目的是更新关于重要甾体激素如糖皮质激素、雌激素和 D 激素（维生素 D）的最新作用机制和作用机制，以便优化其治疗用途。
内源性糖皮质激素的产生具有昼夜节律，在风湿性疾病的外源性低剂量长期糖皮质激素替代治疗中必须遵守这一节律。雌激素增强体液免疫反应并增加细胞增殖。因此，雌激素是自身免疫发展的一个危险因素，其在活动性免疫介导性疾病患者中的治疗应用应避免。维生素 D 作为胆固醇在皮肤中合成，是一种真正的甾体激素（D 激素）。慢性风湿性疾病中 D 激素的免疫抑制活性降低，因为激素的血浆水平低，这证明了其治疗用途。
随着最近基础和临床研究成果的出现，现在可以优化糖皮质激素、雌激素或 D 激素等甾体激素的治疗用途。
