Störungen des Hormonsystems und des Nervensystems bei rheumatoider Arthritis

Zusammenfassung

Im Laufe der letzten zwei Dekaden wurden bei rheumatoider Arthritis (RA) vielfach Störungen des Hormonsystems und des peripheren und zentralen Nervensystems beschrieben. Exemplarisch seien hier nur folgende wichtigen Veränderungen genannt: 1. Verlust der antiinflammatorisch wirksamen adrenalen Androgene in Relation zu proproliferativen antiapoptotischen Östrogenen, 2. inadäquate niedrige Sekretion von Cortisol in Relation zum Entzündungsausmaß, 3. rascher Abbau von Androgenen im synovialen Entzündungsgebiet, 4. Vorherrschen von 16-hydroxylierten proproliferativen Östrogenen im synovialen Entzündungsgebiet, 5. erhöhter Cortisolabbau im synovialen Entzündungsgebiet, 6. verminderte Reagibilität der Hypothalamus-Hypophysen-Nebennieren-(HHN)-Achse in Stresssituationen, 7. Verlust antiinflammatorischer sympathischer Nervenfasern in Relation zu proinflammatorischen sensiblen Nervenfasern im synovialen Entzündungsgebiet, 8. erhöhter systemischer Sympathikotonus und 9. psychische Alterationen wie chronische Müdigkeit und Depression als Folge erhöhter zirkulierender Zytokine. Diese Erkenntnisse aus dem Bereich der Neuroendokrinologie ergänzen die wichtigen Befunde aus der Immunologie. Auf dem Boden dieser Befunde ergeben sich neue Aspekte für die Pathophysiologie der RA und neue therapeutische Möglichkeiten.

Abstract

In the two prior decades, a multitude of endocrine and nervous system alterations have been described in patients with rheumatoid arthritis. This review demonstrates some important examples: 1. Loss of adrenal antiinflammatory androgens in relation to estrogens, 2. inadequate secretion of adrenal cortisol in relation to systemic inflammation, 3. rapid degradation of androgens in the inflamed synovial microenvironment, 4. high levels of anti-apoptotic 16alpha-hydroxylated estrogens in inflamed synovium, 5. increased cortisol degradation in inflamed synovial tissue, 6. decreased reactivity of the hypothalamic-pituitary-adrenal axis in stressful situations, 7. loss of antiinflammatory sympathetic nerve fibres in relation to proinflammatory sensory nerve fibres in inflamed synovium, 8. increased systemic sympathetic tone, and 9. psychological alterations with chronic fatigue and symptoms of depression due to elevated circulating cytokines. Understanding these neuroendocrine alterations helps to sort out the complex pathophysiological puzzle of rheumatoid arthritis. In addition, comprehension of neuroendocrine aberrations triggers research into novel therapeutic targets for the treatment of patients with rheumatoid arthritis.

Schlüsselwörter

Rheumatoide Arthritis - Hormone - Nervensystem

Key words

Rheumatoid arthritis - hormones - nervous system

Literatur

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