Motta Francesca, Di Simone Nicoletta, Selmi Carlo
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, Milan, Italy.
Clin Rev Allergy Immunol. 2025 Mar 21;68(1):32. doi: 10.1007/s12016-025-09031-8.
The prevalence of autoimmune and rheumatological diseases is significantly higher in women, likely due to the effect of sex hormones influencing the development and function of the immune system, a phenomenon observed particularly during pregnancy. Oestrogens, in particular, appear to be a major factor in modulating the immune response, as their receptors are present in nearly all immune cells, where they regulate the expression of genes involved in inflammation. However, there is limited data on how menopause impacts autoimmune diseases, despite evidence suggesting that the menopausal perturbation of hormone levels may lead to the development of autoimmune conditions or alter the course of an already established disease. This review focuses on rheumatic conditions, aiming to provide a comprehensive understanding of how menopause influences the onset, progression, and clinical features of autoimmune diseases. The best evidence is available for rheumatoid arthritis and systemic lupus erythematosus, two paradigmatic autoimmune diseases in which menopause elicits opposite outcomes. Despite these data, there is a notable lack of evidence and research on the impact of menopause in other inflammatory arthritis and connective tissue diseases. This gap highlights a crucial area for future research and unmet needs to be addressed. Understanding how menopausal changes impact autoimmunity and rheumatic diseases will be crucial for improving the management of autoimmune and rheumatological diseases in women.
自身免疫性疾病和风湿性疾病在女性中的患病率显著更高，这可能是由于性激素对免疫系统的发育和功能产生影响，这种现象在孕期尤为明显。特别是雌激素，似乎是调节免疫反应的主要因素，因为其受体几乎存在于所有免疫细胞中，在这些细胞中它们调节参与炎症的基因的表达。然而，关于更年期如何影响自身免疫性疾病的数据有限，尽管有证据表明更年期激素水平的紊乱可能导致自身免疫性疾病的发生或改变已确诊疾病的病程。本综述聚焦于风湿性疾病，旨在全面了解更年期如何影响自身免疫性疾病的发病、进展和临床特征。关于类风湿关节炎和系统性红斑狼疮有最好的证据，这两种典型的自身免疫性疾病中更年期会引发相反的结果。尽管有这些数据，但关于更年期对其他炎症性关节炎和结缔组织疾病的影响，明显缺乏证据和研究。这一差距凸显了未来研究的一个关键领域以及有待满足的未竟需求。了解更年期变化如何影响自身免疫和风湿性疾病对于改善女性自身免疫性疾病和风湿性疾病的管理至关重要。
