The hypothalamic-pituitary-adrenal axis in the pathogenesis of rheumatic diseases

There is bi-directional interaction between the immune system and neuroendocrine axes by virtue of shared mediators and receptors. Several animal models have served to delineate a counter-regulatory role for the hypothalamic-pituitary-adrenal axis in autoimmune inflammatory diseases. In rheumatic diseases, such as rheumatoid arthritis and systemic lupus, there is evidence of altered neuroendocrine function. Stress axis dysregulation also may contribute to the pathobiology of noninflammatory rheumatic pain syndromes.