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However, it is now known that several cell types can generate active glucocorticoids within their cytoplasm through expression of the 11\u03b2\u2010hydroxysteroid dehydrogenase type 1 (11\u03b2\u2010HSD1) enzyme. In a more limited range of cell types, glucocorticoids can be inactivated by the related 11\u03b2\u2010HSD2 enzyme. Both enzymes are regulated by inflammation in various settings. In rheumatoid arthritis, 11\u03b2\u2010HSD activity is present in the inflamed synovium and appears to influence articular and extraarticular disease processes. The generation of active glucocorticoids in the synovium is strongly linked to the level of inflammation. This local production of glucocorticoids is likely to have paracrine consequences and could underpin inflammation\u2010associated bone loss. 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