EditorialPolycystic ovarian syndrome and rheumatoid arthritis: possible physiopathogenetic clues to hormonal influences on chronic inflammation
Section snippets
Interpretation of available data on hormonal risks of RA
An integrative interpretation of available data on hormonal and reproductive risk factors for RA remains provisional. Nevertheless, new biologic constructs of neuroendocrine immune mechanisms in RA may provide fuller understandings of this mysterious disease (Table 1) 11, 14, 15, 16, 17, 18. Multisystem perturbations, including the neuroendocrine immune and endothelial-microvascular consequences of smoking 19, 20, have been shown to occur long before clinical onset of inflammatory joint
Do hormonal factors have varying influences on different host subsets of RA?
No certainty exists that one or another hormonal perturbation definitely increases the risk of RA in any particular host subset. Nevertheless, perturbations of hypothalamic-pituitary-adrenal axis function are implicated strongly in a subset of premenopausal-onset RA. Originally, low serum DHEAS levels per se and other adrenal androgen deficiencies were implicated as factors in RA 14, 23. More likely, subtle glucocorticoid insufficiency is a contributory factor in a minority of young women with
Would PCOS and RA in elderly women reflect a risk or protective association?
In this issue of the Seminars in Arthritis and Rheumatism, Merlino et al (32) reported an association of a preceding diagnosis of PCOS with incident RA in elderly women. In a cohort study of 31,336 Iowa women aged 55 to 69 years at baseline in 1986, 5 (3.2%) of 158 incident RA cases reported having a physician diagnosis of PCOS versus 1.35% in the total cohort. The cases were verified by specified RA criteria and had symptom onset after January 1, 1987. The mean follow-up was 11 years, or
Dissociation of the serum DHEAS to cortisol ratio in younger-onset, but not older-onset RA
Among 11 premenopausal women who developed RA before age 50 years, serum DHEAS and cortisol levels were significantly (P = .027) negatively correlated (−0.660), an average of 12 years before disease onset 13, 33. However, among 25 pre-RA women who subsequently developed onset of disease at age 50 years or older, DHEAS and cortisol levels were positively correlated (+0.377, P = .064) 13, 33. The DHEAS and cortisol correlations differed between the younger (ie,−0.660) and older (ie, +0.377)
Overview perspectives
The findings of this study (32) have generated more questions than answers. PCOS is a highly prevalent disorder that affects approximately 7% of women of reproductive age. Multiple pathologies are expressed in PCOS as gonadotropindependent ovarian hyperandrogenism in women, with a genetic propensity to develop hyperfunctional oligo-anovulatory ovaries producing excessive amounts of androgens 26, 27. Most women with PCOS belong in the 25% of women with insulin resistance, and the majority of
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Cited by (0)
- 1
Alfonse T. Masi, MD, DRPH, MACR: Department of Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL;
- 2
George P. Chrousos, MD, FAAP, FACP, MACE: Chief, Pediatric and Reproductive Endocrinology Branch, National Institute of Child Health and Human Development, NIH Clinical Center, Bethesda, MD.