Abstract
The relationship between endocrine hormones and the spectrum of rheumatic conditions has long been discussed in the literature, focusing primarily on sexual hormones, such as estrogens, androgens, prolactin (PRL). Estrogens are indeed involved in the pathogenesis of the main inflammatory arthritis thanks to their effects on the immune system, both stimulatory and inhibitory. The PRL system has been discovered in synovial tissue of rheumatoid arthritis (RA) and psoriatic arthritis (PsA), patients and has been propose as a new potential therapeutic target. Besides sexual hormones, in the last years scientific interest about the crosstalk of immune system with other class of hormones has grown. Hormones acting on the bone tissue (i.e. parathyroid hormone, vitamin D) and modulators of the Wnt pathway (i.e. Dickkopf-1) have been demonstrated to play active role in inflammatory arthritis course, defining a new field of research named osteoimmunology. PTH, which is one of the main determinants of Dkkopf-1, plays a crucial role in bone erosions in RA and a correlation between PTH, Trabecular Bone Score (TBS) and disease activity has been found in ankylosing spondylitis (AS). In PSA is under studying the interaction among IL-17 and bone metabolism. The purpose of this review is to discuss and summarize the recent data about the interaction between endocrine hormone and immune system in the main rheumatic disorders, covering in particular the role of bone-related hormones and cytokines. We will describe this relationship from a biochemical, diagnostic and therapeutic perspective, with a particular focus on RA, PsA and AS.
Highlights
Hormones are involved in various aspects of the immune response and rheumatic diseases
Among the factors that influence Dickkopf-related protein 1 (Dkk-1) and sclerostin, we find several hormones, such as estrogens, androgens, parathyroid hormone (PTH) and vitamin D [12]
In a very recent study [116], we showed an increase in Dkk-1 serum levels in treatment-naive Polymyalgia rheumatica (PMR) patients
Summary
Hormones are involved in various aspects of the immune response and rheumatic diseases. A significant trabecular and cortical intra‐articular bone loss was observed, similar to the impairment that characterizes the bone microstructure after the menopause [54] These microstructural features in RA patients correlate with disease activity, with serum levels of pro‐inflammatory cytokines and, as already mentioned, with serum levels of Dkk-1 and PTH, as a consequence of a common pathological mechanism of both inflammatory and metabolic nature [32, 56, 57]. For these reasons, we speculated that osteoporosis might be a significant and independent determinant of bone erosions in RA [10]. A dysregulation in the Wnt/beta-catenin signaling has been observed in B and T cells involved in SLE pathogenesis and among bone mediators, Dkk-1 has been suggested as a potential biomarker for bone erosions [118] and as an independent biomarker for lupus nephritis [131]
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