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[Rheumatoid arthritis - pathogenetic role of neuroendocrine axes and the peripheral nervous system]
Peter Härle1, Maurizio Cutolo, Jürgen Schölmerich
1Labor für Neuroendokrinimmunologie, Klinik und Poliklinik für Innere Medizin I, Universität Regensburg.
Background:
Local innate and adaptive immune processes are of importance during the acute phase of rheumatoid arthritis (RA). In the advanced inflammatory phase alterations of systemic anti-inflammatory feedback mechanisms might be important features which may support chronic inflammation.
Alterations:
Similarly, like in other chronic inflammatory diseases, inadequately low cortisol and androgen serum levels can be detected in RA patients. In addition, there is a marked reduction of anti-inflammatory sympathetic nerve fibers in the inflamed joints paralleled by an enhanced number of pro-inflammatory sensory nerve fibers. Thus, an uncoupling of synergistically acting endocrine and neuronal, anti-inflammatory mechanisms (cortisol, dehydroepiandrosterone, androgens, sympathetic neurotransmitters) and a preponderance of pro-inflammatory mechanisms (estrogens, sensory neurotransmitters) may lead to chronic inflammatory disease.
Conclusion:
From this pathogenetic point of view new therapeutic strategies could be developed for the treatment of patients with RA.