Hormônios sexuais e autoimunidade
| Article Title: | The connective tissue diseases and the overall influenceof gender. | ||
| Article Source: | Int J Fertil Menopausal Stud 1996 Mar-Apr;41(2):156-65 | ||
| Author(s): | Lahita RG | ||
| Abstract: | The autoimmune diseases are more common in women than men.The actual prevalence ranges from the high of 10 to 15 females for eachmale for systemic lupus erythematosus to four females for every male with rheumatoid arthritis. Though these diseases are found in the veryyoung and the aged, the high prevalence is observed after puberty in mostpatients. These diseases vary with regard to severity, and most investigators suspect that the signs and symptoms of these diseases vary with menstrual cycle and change severity during pregnancy. The collagen diseases are devastatingto the health of young women. Rheumatoid arthritis occurring ata mean age of 40 years results in debilitating erosive changes in bonewith morning stiffness and eventual crippling. Systemic lupus erythematosus, Sjogren's syndrome and others, common to women of the childbearing years,act in several ways to destroy organ systems of the body. Virtually anyorgan system of the female anatomy can be affected by these illnesses.In the case of lupus, the disease has protean manifestations, such as procoagulation, renal destruction, skin disease, unrelenting arthropathy and arthritis,and encephalopathy (to name only a few). The underlying mechanisms arenot known; however, the immune system acts to destroy tissue via immunecomplex deposition and through the action of cytotoxic lymphocyte activity.There is an association of both clinical signs and autoantibody subpopulationswith markers of the HLA-D or MHC II locus on chromosome 6. No constitutivegene for any of the collagen vascular diseases has been identified in the human. Evidence exists to support an altered metabolism of estrogens andandrogens in patients with these diseases. Recent data also indicate that increased estrogen levels might initiate autoimmune diseases in many womenand men. Estrogen hydroxylation is increased in both men and women with autoimmune diseases like lupus. The mechanisms are unknown, although estrogenicmetabolites have been shown to increase B cell differentiation and activateT cells. Moreover, isolated cases of hyperprolactinemia have been observedin association with these hyperestrogenic states, and treatment of hyperprolactinemiahas been shown to ameliorate diseases like lupus. Androgen oxidation isalso increased in patients with autoimmune disease, but this abnormalityhas been observed only in patients with lupus, and only women at that.The result is that women with autoimmune diseases like lupus and rheumatoid arthritis have lower plasma androgens than control cases. These data have supported the use of weak androgens, e.g., DHEA, for thetreatment of lupus. | ||
| Author's Address: | Division of Rheumatology and Connective Tissue Diseases,Roosevelt/St. Lukes Medical Center, New York, New York, USA. | ||
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