Sex hormone modulation in systemic lupus erythematosus: still a therapeutic option?

Article Abstract:

Estrogens and androgens, the female and male sex hormones, affect the function of the immune system, as is indicated by the great difference between the sexes in prevalence of autoimmune diseases, which are characterized by inappropriate production of antibodies against the body's own molecules. Women more often have these diseases, particularly systemic lupus erythematosus (SLE). Differences in the occurrence of symptoms such as increased joint pain, fever, and malaise during the menstrual period indicate that varying levels of the sex hormones contribute to disease status in lupus. The use of estrogens for birth control is also associated with disease flares, and some feel this use may be related to development of movement disorders and clot formation. The mechanism of estrogens and other hormones is not clear, but glands and cells in the immune system may be responsive to them. Metabolism of sex hormones differs in women with SLE, especially during active disease, and this has prompted the use of medications with anti-estrogenic or pro-androgenic activity. Androgens have generally been disappointing, either due to lack of effect or to significant side effects. These drugs may actually worsen the disease in men, but some women, especially those with thrombocytopenia (low platelet levels) have benefited from treatment from danazol, presumably due to its suppression of native estrogens. Cyproterone, which is structurally related to progesterone, suppresses estrogen production and ovulation. Its effects on androgen-responsive sites vary. Women with SLE given the drug had fewer disease flares and experienced great improvements in mouth ulcers. Because the basic effects of hormones on the immune system are not fully understood, more research will be necessary before the potential therapeutic effects of hormones and hormone-like medications in SLE can be appreciated. (Consumer Summary produced by Reliance Medical Information, Inc.)

Editorial, Hormones, Sex, Sex hormones

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Acquired Brown's syndrome in a patient with systemic lupus erythematosus

Article Abstract:

A patient with systemic lupus erythematosus (SLE) was diagnosed with bilateral Brown's syndrome, a disorder characterized by an abnormality in the movement of the affected eye. SLE is a chronic inflammatory disorder that affects the connective tissue, the framework or structural tissue of the human body. A 27-year-old woman with a four-year history of SLE had been suffering from double vision over a six-day period. Her double-vision worsened during sideways and upward gazes. An ophthalmological examination revealed limitations in the movement of both eyes. She was diagnosed with Brown's syndrome and treated with the corticosteroid drug prednisone. Her symptoms disappeared within two days of beginning treatment with the corticosteroid. She continued to receive treatment with prednisone with a gradual decrease in dosage over the first several weeks of treatment.

Causes of, Complications and side effects, Diplopia

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New methods of treatment in an experimental murine model of systemic lupus erythematosus induced by idiotypic manipulation

Article Abstract:

Preliminary studies with mice have shown that treatment with anti-estrogens, testosterone, intravenous immunoglobulin, bromocriptine, or anti-CD4 antibodies may be the most likely study treatments to pursue for human patients with systemic lupus erythematosus. Researchers simulated autoimmune disease in specialized mice through an immunization process. These treatments varied in their effectiveness from preventing disease expression, to reducing the disease's effects, to providing complete remission. These treatments may be most effective though if used early in the disease cycle.

Testosterone, Immunoglobulins, Estrogen, Bromocriptine, Estrogen antagonists

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