11263762

Source:http://linkedlifedata.com/resource/pubmed/id/11263762

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Predicate	Object
rdf:type	pubmed:Citation
lifeskim:mentions	umls-concept:C0003873, umls-concept:C0018067, umls-concept:C0035820, umls-concept:C0205373, umls-concept:C0206417, umls-concept:C0282411, umls-concept:C1314939, umls-concept:C1522496, umls-concept:C1527178, umls-concept:C1705938
pubmed:issue	3
pubmed:dateCreated	2001-3-23
pubmed:abstractText	From the compendium presented above, the following statements become evident: 1) Inappropriately low secretion of cortisol in relation to inflammation is a typical feature of the inflammatory disease in patients with RA. 2) The secretion of adrenal androgens is significantly reduced, which is a problem in postmenopausal women and elderly men due to a lack of downstream sex hormones. 3) Serum levels of testosterone are markedly reduced in RA. 4) Sympathetic nerve fibers are markedly reduced in the synovial tissue of patients with RA, whereas proinflammatory sensory fibers (substance P) are present. 5) Substance P serves to continuously sense painful stimuli in the periphery, and the nociceptive input from the inflamed joint shows a large amplification in the spinal cord. This leads to continuous pain with stabilization of the afferent sensory input and continuous release of proinflammatory substance P into the lumen of the joint. From these facts it is obvious that alterations of the systemic antiinflammatory feedback systems contribute significantly to the pathogenesis of RA. Disease therapy directed at these alterations must provide a mechanism to replace the adrenal glands (glucocorticoids), the gonadal glands (androgens), and the sympathetic nervous system (adenosine increase by low-dose MTX, sulfasalazine, and salicylates) in order to integrate their immunosuppressive effects at the local site of synovial inflammation. Although local processes of the adaptive immune system are important in pathogenesis in the acute phase of RA, these mechanisms may be less important during the chronic phase of the disease in the absence of a specific trigger. We believe that a defect of systemic antiinflammatory feedback systems is an 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.
pubmed:language	eng
pubmed:journal	http://linkedlifedata.com/resource/pubmed/journal/0370605
pubmed:citationSubset	AIM
pubmed:status	MEDLINE
pubmed:month	Mar
pubmed:issn	0004-3591
pubmed:author	pubmed-author:CutoloMM, pubmed-author:StraubR HRH
pubmed:issnType	Print
pubmed:volume	44
pubmed:owner	NLM
pubmed:authorsComplete	Y
pubmed:pagination	493-507
pubmed:dateRevised	2006-11-15
pubmed:meshHeading	pubmed-meshheading:11263762-Arthritis, Rheumatoid, pubmed-meshheading:11263762-Humans, pubmed-meshheading:11263762-Hypothalamo-Hypophyseal System, pubmed-meshheading:11263762-Peripheral Nervous System, pubmed-meshheading:11263762-Pituitary-Adrenal System
pubmed:year	2001
pubmed:articleTitle	Involvement of the hypothalamic--pituitary--adrenal/gonadal axis and the peripheral nervous system in rheumatoid arthritis: viewpoint based on a systemic pathogenetic role.
pubmed:affiliation	Department of Internal Medicine I, University Hospital, Regensburg, Germany.
pubmed:publicationType	Journal Article, Review, Research Support, Non-U.S. Gov't