Rheumatoid arthritis and juvenile chronic arthritis: the role of the neuro-endocrine system.

Various factors determine the outcome of rheumatoid arthritis and juvenile chronic arthritis. One of these factors is the neuro-endocrine system. In rheumatoid arthritis as well as in juvenile chronic arthritis, alterations of the autonomous nervous system do occur. In polyarticular and systemic juvenile chronic arthritis, during active disease the sensitivity for catecholamines changes. Under these conditions catecholamines cannot inhibit the immune response, which may have negative consequences for the course of the disease. In certain autoimmune animal models defects in the hypothalamus-pituitary-adrenal axis play a role in the pathogenesis of the disease. Studies in rheumatoid arthritis suggest a subtle insufficiency of the hypothalamus-pituitary-adrenal-axis in rheumatoid arthritis. Proinflammatory substances such as Substance P, as well as (locally produced) opioids may contribute to disease activity.