rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.47360/1995-4484-2022-538-545rsp-3220Research ArticleОБЗОРЫ И ЛЕКЦИИREVIEWS AND LECTURESПатогенетическое обоснование назначения менопаузальной гормонотерапии при системной склеродермииPathogenetic rationale for prescribing menopausal hormone therapy for systemic sclerosishttps://orcid.org/0000-0002-5290-156XПаневинТ. С.PanevinT. S.

115522,  Москва, Каширское шоссе, 34а

115522, Moscow, Kashirskoye Highway, 34A

tarasel@list.ruhttps://orcid.org/0000-0002-3248-6426АнаньеваЛ. П.AnanyevaL. P.

115522,  Москва, Каширское шоссе, 34а

115522, Moscow, Kashirskoye Highway, 34A

ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой»РоссияV.A. Nasonova Research Institute of RheumatologyRussian Federation202211112022605538545Copyright © Паневин Т.С., Ананьева Л.П., 20222022Паневин Т.С., Ананьева Л.П.Panevin T.S., Ananyeva L.P.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://rsp.mediar-press.net/rsp/article/view/3220

Системная склеродермия (ССД) характеризуется дисрегуляцией врожденной и адаптивной иммунной системы, васкулопатией и генерализованным фиброзом. Как и при большинстве аутоиммунных заболеваний, среди пациентов превалируют женщины, которые заболевают в 3–14 раз чаще, чем мужчины. Предполагается, что гендерные различия и модуляция половых гормонов имеют существенное значение в патогенезе ССД. Эстрогены способны влиять на иммунный ответ, оказывать сосудорасширяющее действие и стимулировать синтез коллагена в коже. Развитие ССД приводит к значимому снижению качества жизни, психологическим нарушениям, ассоциированным с изменением внешности, а также к необходимости пожизненного приема препаратов с нередким развитием неблагоприятных реакций. Возрастной дефицит эстрогенов, ассоциированный с наступлением менопаузы, сопровождается снижением качества жизни и в ряде случаев изменением клинических проявлений соматических заболеваний. В данном обзоре рассмотрено влияние менопаузы и менопаузальной гормональной терапии (МГТ) на течение и клинические проявления ССД. Отмечено, что ССД в ряде случаев сопровождается ранним наступлением менопаузы. Применение МГТ не ассоциируется с прогрессированием кожного фиброза и может уменьшать сосудистые проявления ССД.

Systemic scleroderma (SS) is characterized by dysregulation of the innate and adaptive immune systems, vasculopathy, and generalized fibrosis. As with most autoimmune diseases, women predominate among patients, who get sick 3–14 times more often than men. It is assumed that gender differences and modulation of sex hormones are essential in the pathogenesis of SS. Estrogens are able to influence the immune response, have a vasodilating effect and stimulate the synthesis of collagen in the skin. The development of SS leads to a significant decrease in the quality of life, psychological disorders associated with changes in appearance, as well as the need for lifelong medication with the frequent development of side effects. Age-related estrogen deficiency associated with the onset of menopause is accompanied by a decrease in the quality of life and, in some cases, a change in the clinical manifestations of somatic diseases. This review considers the impact of menopause and menopausal hormone therapy (MHT) on the course and clinical manifestations of systemic scleroderma. It is noted that SS in some cases is accompanied by an early onset of menopause. The use of MHT is not associated with the progression of cutaneous fibrosis, and may also improve the vascular manifestations of SS.

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The authors declare that there are no conflicts of interest present.