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Acta rheumatologica Belgradensia
2002, vol. 32, iss. 1, pp. 27-41
article language: Serbian
Actual Topics
Involvement of the hypothalamic-pituitary-adrenal/gonadal axis and the peripheral nervous system in rheumatoid arthritis
aUniverzitet u Beogradu, Medicinski fakultet, Institut za reumatologiju
bInstitut za endokrinologiju, dijabetes i bolesti metabolizma Beograd

Abstract

Rheumatoid arthritis is a multifactorial disease that results in severe destruction in the microenvironment of the synovial tissue, cartilage, and juxtaarticular bone. A hallmark of local, inflammation is the secretion of huge amounts of proinflammatory immune mediators such as cytokines, e.g., tumor necrosis factor and interleukin 1. Local secretion of cytokines and activation of immunocompetent cells in the microenvironment are followed by a systemic reaction. As a result of involvement of nonarticular structures, the endocrine system and the nervous system participate directly in the pathophysiology of RA. Since mediators of the endocrine system(e.g., steroid hormones) and the peripheral nervous system(e.g., norepinphrine or substance P) reach synovial target cells, which are provided with specific receptors, these systemic feedback systems have the potential to modulate the local inflammatory process in RA. From the compendium presented in this review it is obvious that alterations of the systemic anti-inflammatory feedback system contribute significantly to the pathogenesis of RA. We believe that a defect of systemic anti-inflammatory feedback systems is important factor in the perpetuation of RA. This review reinforces the belief that combined therapeutic approaches on a neuroendocrine immune basis are of crucial importance in a pathogenetically oriented therapy of RA.

Keywords

References

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