Hormone therapy in rheumatic diseases.
OBJECTIVE
Steroid hormones are deeply involved in the pathophysiology of immune-mediated rheumatic diseases and used for their treatment. Purpose of the review is to update on recent roles and mechanisms of action of important steroid hormones such as glucocorticoids, estrogens, and D hormone (vitamin D) in order to optimize their therapeutical use.


RESULTS
Endogenous glucocorticoids are characterized by a circadian rhythm of production that must be respected in case of exogenous low-dose long-term glucocorticoid replacement therapy of rheumatic diseases. Estrogens are enhancers of the humoral immune response and increase cell proliferation. Therefore, estrogens represent a risk factor for the development of autoimmunity and their therapeutical use must be avoided in patients with active immune-mediated diseases. Vitamin D, as synthesized in the skin from cholesterol, is a real steroid hormone (D hormone). The immunosuppressive activities of D hormone are reduced in chronic rheumatic diseases, as low plasma levels of the hormone are evident and justify its therapeutical use.


CONCLUSIONS
The optimization of the therapeutical use of steroid hormones such as glucocorticoids, estrogens or D hormone is now possible following recent basic and clinical research achievements.
Cutolo
Maurizio
M
University of Genova, Italy. mcutolo@unige.it
D015551:Autoimmunity / Q000187:drug effects / Q000502:physiology; D002940:Circadian Rhythm / Q000187:drug effects / Q000502:physiology; D002985:Clinical Protocols; D004967:Estrogens / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D005938:Glucocorticoids / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D006728:Hormones / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D006801:Humans; D012216:Rheumatic Diseases / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D018570:Risk Assessment; D013256:Steroids / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D014807:Vitamin D / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use
D004967:Estrogens; D005938:Glucocorticoids; D006728:Hormones; D013256:Steroids; D014807:Vitamin D