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Publisher Summary The predominance of autoimmune disease in women may be attributable to the interaction between sex hormones and the immune system. Sex hormones can exert local actions in the tissues in which they are formed or have additional actions because they enter the circulation. In autoimmune rheumatic diseases, local effects of sex hormones seem to be related to modulation of cell proliferation and cytokine production. Many conditions may change serum estrogen levels and their peripheral conversion rate, thereby inducing an altered androgen:estrogen ratio. An accelerated peripheral metabolic conversion of androgen precursors to more estrogenic metabolites such as 17β-estradiol (E2) has been implicated in patients who have systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA). Moreover, several studies and reviews strongly support the idea that there are decreased serum levels of dehydroepiandrosterone (DHEA), testosterone, and progesterone in male and female patients with SLE and related autoimmune diseases. These observations provide a basis for the continued exploration of the proper use of exogenous hormones for contraception, hormone replacement therapy, and even treatment of autoimmune diseases. As patients suffering from autoimmune rheumatic diseases are predominantly young females between the ages of 20 and 40 years, which is the period of highest childbearing potential, particular attention must be paid to the impact oral contraceptives have on these diseases. The relationship between oral contraceptives and autoimmune diseases is complex. This chapter reviews the current status of oral contraceptives in autoimmune diseases, including systemic lupus erythematosus, rheumatoid arthritis, Sjogren's syndrome, antiphospholipid syndrome, scleroderma, and systemic vasculitis. |
