Jakubaszek Michał Piotr
Early Arthritis Clinic, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland.
Reumatologia. 2023;61(4):264-270. doi: 10.5114/reum/170319. Epub 2023 Aug 31.
Does prolactin (PRL) level testing in the diagnosis of systemic connective tissue diseases make sense and should we test it in everyday practice?
Connective tissue diseases (CTDs) are a group of heterogeneous disorders, involving multiple body systems. Rheumatoid arthritis (RA) is one of the most common connective tissue diseases with a global prevalence of 0.3-1% and can be inherited. Less common are systemic lupus erythematosus (SLE), antiphospholipid syndrome (APS), systemic sclerosis (SSc), primary Sjögren's syndrome (pSS) and inflammatory myositis. Prolactin is responsible for lactation, breast growth and many other bodily processes, and is elevated in blood of woman who are pregnant or breastfeeding. Hyperprolactinemia is relatively common in women, so some rheumatic diseases may be caused by high prolactin levels, and it should be detected during diagnosis.
Prolactin signals are found in arthritic joint tissues (chondrocytes and synovial fibroblasts) to inhibit cartilage degradation, synovitis and osteoclastogenesis. On the other hand, hyperprolactinemia also promotes the conversion of PRL to vasoinhibin, a fragment of PRL that directly stimulates and indirectly inhibits arthritis in a cell type-dependent manner. The role of the PRL/vasoinhibin axis in inflammatory arthritis should still be monitored and further research is needed to help elucidate the role of PRL in rheumatic diseases in order to ultimately develop new therapeutic interventions that can be tested in patients.
Nowadays, there are no clear indications for prolactin testing in the diagnosis of systemic connective tissue diseases. In the case of suspicion or confirmation of some systemic connective tissue diseases, such as rheumatoid arthritis or systemic lupus erythematosus, testing the prolactin level makes sense when severity of disease symptoms is observed.
催乳素（PRL）水平检测在系统性结缔组织疾病的诊断中是否有意义，我们在日常实践中是否应该进行此项检测？
结缔组织疾病（CTD）是一组异质性疾病，累及多个身体系统。类风湿关节炎（RA）是最常见的结缔组织疾病之一，全球患病率为0.3 - 1%，且可能具有遗传性。系统性红斑狼疮（SLE）、抗磷脂综合征（APS）、系统性硬化症（SSc）、原发性干燥综合征（pSS）和炎性肌病则相对少见。催乳素负责泌乳、乳腺生长及许多其他身体过程，在怀孕或哺乳期女性的血液中水平会升高。高催乳素血症在女性中相对常见，因此一些风湿性疾病可能由高催乳素水平引起，在诊断过程中应予以检测。
在关节炎关节组织（软骨细胞和滑膜成纤维细胞）中发现催乳素信号可抑制软骨降解、滑膜炎和破骨细胞生成。另一方面，高催乳素血症还会促进PRL转化为血管抑制素，血管抑制素是PRL的一个片段，它以细胞类型依赖的方式直接刺激并间接抑制关节炎。PRL/血管抑制素轴在炎性关节炎中的作用仍需监测，需要进一步研究以阐明PRL在风湿性疾病中的作用，从而最终开发出可在患者中进行测试的新治疗干预措施。
目前，在系统性结缔组织疾病的诊断中，尚无明确的催乳素检测指征。在怀疑或确诊某些系统性结缔组织疾病，如类风湿关节炎或系统性红斑狼疮时，当观察到疾病症状严重程度时，检测催乳素水平是有意义的。
