HORMONAL AND PREGNANCY RELATIONSHIPS TO RHEUMATOID-ARTHRITIS - CONVERGENT EFFECTS WITH IMMUNOLOGICAL AND MICROVASCULAR SYSTEMS

Objective: To review sex hormones and rheumatoid arthritis (RA) and th e interrelationships between hormonal, immunological, and vascular sys tems. Data Sources: Publications detailing serum sex hormone levels an d their HLA interactions, steroidogenesis, pregnancy, and therapeutic uses of sex hormones in RA. Study Selection: Controlled studies of sex hormone levels in RA patients not previously treated with glucocortic oids. Data Extraction: Mean (+/-SD) serum levels of dehydroepiandroste rone sulfate (DHEAS), testosterone (T), and estradiol (E2). Data Synth esis: Mean (+/-SD) levels were collated into tables for women with pre - versus postmenopausal onsets of disease and men. Data were also orde red across all study groups by increasing mean levels of the control s ubjects. Pooled data were summarized statistically, and major sources of variation between the studies were identified. Conclusions: Serum D HEAS, an adrenal androgen, was impressively decreased among women with premenopausal onset of RA. One study showed such deficiency years bef ore disease onset. Serum T was somewhat decreased in the premenopausal onset group, but could be explained by decreased peripheral conversio n of the lower levels of adrenal androgens. Women with postmenopausal onset of RA had modestly decreased serum DHEAS levels overall, but no difference in serum T, compared with controls. Male RA cases had consi stently decreased serum levels of T, but not of DHEAS. Serum E2 was co mparable in all RA versus control groups. The complex biology of pregn ancy was interpreted as an example of vital interactions between hormo nal, immunological, and vascular systems, as they may relate to the ph ysiopathology of RA. The major age, sex, and hereditable determinants of RA were compared within a composite table of estimated relative ris ks. Elucidation of the interacting risk factors offers promising avenu es of research in this complex disease. (C) 1995 by W.B. Saunders Comp any