{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T14:29:54Z","timestamp":1774535394380,"version":"3.50.1"},"reference-count":91,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2023,8,25]],"date-time":"2023-08-25T00:00:00Z","timestamp":1692921600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>The neural, the endocrine, and the immune systems are studied as distinct districts in physiological and pathological settings. However, these systems must be investigated with an integrative approach, while also considering that therapeutic agents, such as glucocorticoids, can induce a reversible or irreversible change of this homeostasis. Children and adolescents affected by rheumatic diseases frequently need treatment with corticosteroids, and the treatment must sometimes be continued for a long time. In the biological era, the treat-to-target strategy allowed a real revolution in treatment, with significant steroid dose sparing or, in many patients, steroid treatment withdrawal. In this review, the impact of glucocorticoids on endocrine, immune, and neurologic targets is analyzed, and the crosstalk between these systems is highlighted. In this narrative review, we explore the reasoning as to why glucocorticoids can disrupt this homeostasis, we summarize some of the key results supporting the impact of glucocorticoids treatment on endocrine, immune, and neurologic systems, and we discuss the data reported in the international literature.<\/jats:p>","DOI":"10.3390\/ijms241713192","type":"journal-article","created":{"date-parts":[[2023,8,25]],"date-time":"2023-08-25T08:25:33Z","timestamp":1692951933000},"page":"13192","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["\u201cNeuroimmunoendocrinology\u201d in Children with Rheumatic Diseases: How Glucocorticoids Are the Orchestra Director"],"prefix":"10.3390","volume":"24","author":[{"given":"Maria Cristina","family":"Maggio","sequence":"first","affiliation":[{"name":"University Department PROMISE \u201cG. D\u2019Alessandro\u201d, University of Palermo, Via del Vespro 129, 90100 Palermo, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angela","family":"Miniaci","sequence":"additional","affiliation":[{"name":"Paediatric Rheumatology, UOC of Paediatrics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Romina","family":"Gallizzi","sequence":"additional","affiliation":[{"name":"Paediatric Unit, Department of Health Science, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0416-768X","authenticated-orcid":false,"given":"Adele","family":"Civino","sequence":"additional","affiliation":[{"name":"Paediatric Rheumatology and Immunology, Vito Fazzi Hospital, 73100 Lecce, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,8,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1136\/annrheumdis-2018-213902","article-title":"Treat to target (drug-free) inactive disease in DMARD-naive juvenile idiopathic arthritis: 24-month clinical outcomes of a three-armed randomised trial","volume":"78","author":"Muller","year":"2018","journal-title":"Ann. Rheum. Dis."},{"key":"ref_2","first-page":"595","article-title":"The sympathetic nerve\u2014An integrative interface between two supersystems: The brain and the immune system","volume":"52","author":"Elenkov","year":"2000","journal-title":"Pharmacol. Rev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1016\/j.autrev.2007.11.007","article-title":"Stress as a trigger of autoimmune disease","volume":"7","author":"Stojanovich","year":"2008","journal-title":"Autoimmun. Rev."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"921","DOI":"10.3389\/fendo.2019.00921","article-title":"Role of the End-Point Mediators of Sympathoadrenal and Sympathoneural Stress Axes in the Pathogenesis of Experimental Autoimmune Encephalomyelitis and Multiple Sclerosis","volume":"10","year":"2020","journal-title":"Front. Endocrinol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1016\/j.crimmu.2021.11.001","article-title":"Role of adrenergic receptor signalling in neuroimmune communication","volume":"2","author":"Chhatar","year":"2021","journal-title":"Curr. Res. Immunol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1507\/endocrj1954.33.449","article-title":"In vivo evidence of regulation by pituitary-adrenal axis of urinary epinephrine excretion in men","volume":"33","author":"Yanase","year":"1986","journal-title":"Endocrinol. Jpn."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1136\/ard.2005.038059","article-title":"Increase of sympathetic outflow measured by neuropeptide Y and decrease of the hypothalamic-pituitary-adrenal axis tone in patients with systemic lupus erythematosus and rheumatoid arthritis: Another example of uncoupling of response systems","volume":"65","author":"Straub","year":"2006","journal-title":"Ann. Rheum. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Ferrara, G., Petrillo, M.G., Giani, T., Marrani, E., Filippeschi, C., Oranges, T., Simonini, G., and Cimaz, R. (2019). Clinical Use and Molecular Action of Corticosteroids in the Pediatric Age. Int. J. Mol. Sci., 20.","DOI":"10.3390\/ijms20020444"},{"key":"ref_9","first-page":"S157","article-title":"Toward a treat-to-target approach in the management of juvenile idiopathic arthritis","volume":"30","author":"Consolaro","year":"2012","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_10","unstructured":"National Guideline Centre (UK) (2018). Treat-to-Target: Rheumatoid Arthritis in Adults: Diagnosis and Management: Evidence Review C, National Institute for Health and Care Excellence (NICE)."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"bnaa002","DOI":"10.1210\/endrev\/bnaa002","article-title":"Dynamics of ACTH and Cortisol Secretion and Implications for Disease","volume":"41","author":"Lightman","year":"2020","journal-title":"Endocr. Rev."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1080\/019262301301418847","article-title":"Adrenal Gland: Structure, Function, and Mechanisms of Toxicity","volume":"29","author":"Rosol","year":"2001","journal-title":"Toxicol. Pathol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.mce.2013.05.007","article-title":"Extra-adrenal glucocorticoid synthesis: Immune regulation and aspects on local organ homeostasis","volume":"380","author":"Jondal","year":"2013","journal-title":"Mol. Cell. Endocrinol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1126\/science.3283939","article-title":"The steroid and thyroid hormone receptor superfamily","volume":"240","author":"Evans","year":"1988","journal-title":"Science"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"C1324","DOI":"10.1152\/ajpcell.00363.2001","article-title":"Expression of glucocorticoid receptor \u03b1- and \u03b2-isoforms in human cells and tissues","volume":"283","author":"Pujols","year":"2002","journal-title":"Am. J. Physiol. Cell Physiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1016\/j.mad.2004.06.010","article-title":"Mechanisms of glucocorticoid receptor signaling during inflammation","volume":"125","author":"Smoak","year":"2004","journal-title":"Mech. Ageing Dev."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1016\/j.beem.2015.09.001","article-title":"Corticosteroid-binding globulin: Modulating mechanisms of bioavailability of cortisol and its clinical implications","volume":"29","author":"Bae","year":"2015","journal-title":"Best Pract. Res. Clin. Endocrinol. Metab."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.1152\/physrev.00020.2012","article-title":"11\u03b2-Hydroxysteroid Dehydrogenases: Intracellular Gate-Keepers of Tissue Glucocorticoid Action","volume":"93","author":"Chapman","year":"2013","journal-title":"Physiol. Rev."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.rdc.2015.08.002","article-title":"Corticosteroids: Mechanisms of Action in Health and Disease","volume":"42","author":"Ramamoorthy","year":"2016","journal-title":"Rheum. Dis. Clin. N. Am."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/j.mce.2010.04.005","article-title":"The anti-inflammatory and immunosuppressive effects of glucocorticoids, recent developments and mechanistic insights","volume":"335","author":"Coutinho","year":"2011","journal-title":"Mol. Cell. Endocrinol."},{"key":"ref_21","unstructured":"Steven, K. (1997). Adrenal Cortical Steroids. Drug Facts and Comparisons, Facts and Comparisons, Inc.. [5th ed.]."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1038\/ncb1922","article-title":"Ultradian hormone stimulation induces glucocorticoid receptor-mediated pulses of gene transcription","volume":"11","author":"Stavreva","year":"2009","journal-title":"Nat. Cell Biol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"5645","DOI":"10.1073\/pnas.090571897","article-title":"Early-life exposure to endotoxin alters hypothalamic\u2013pituitary\u2013adrenal function and predisposition to inflammation","volume":"97","author":"Shanks","year":"2000","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1186\/s12969-021-00521-5","article-title":"Growth and puberty in children with juvenile idiopathic arthritis","volume":"19","author":"Breda","year":"2021","journal-title":"Pediatr. Rheumatol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1016\/S0140-6736(17)30065-X","article-title":"Intra-articular corticosteroids versus intra-articular corticosteroids plus methotrexate in oligoarticular juvenile idiopathic arthritis: A multicentre, prospective, randomised, open-label trial","volume":"389","author":"Ravelli","year":"2017","journal-title":"Lancet"},{"key":"ref_26","first-page":"1296","article-title":"Linear growth and final height in patients with systemic juvenile idi-opathic arthritis treated with longterm glucocorticoids","volume":"29","author":"Simon","year":"2002","journal-title":"J. Rheumatol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1210\/er.2015-1026","article-title":"Growth and the Growth Hormone-Insulin Like Growth Factor 1 Axis in Children with Chronic Inflammation: Current Evidence, Gaps in Knowledge, and Future Directions","volume":"37","author":"Wong","year":"2015","journal-title":"Endocr. Rev."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/j.jped.2018.07.015","article-title":"Height and sexual maturation in girls with juvenile idiopathic arthritis","volume":"96","author":"Machado","year":"2018","journal-title":"J. Pediatr."},{"key":"ref_29","first-page":"168","article-title":"Disease activity and damage in juvenile idiopathic arthritis: Methotrexate era versus biologic era","volume":"21","author":"Giancane","year":"2019","journal-title":"Thromb. Haemost."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"499","DOI":"10.4049\/jimmunol.144.2.499","article-title":"IL-6 production by human articular chondrocytes. Modulation of its synthesis by cytokines, growth factors, and hormones in vitro","volume":"144","author":"Guerne","year":"1990","journal-title":"J. Immunol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"99","DOI":"10.3109\/03009749709115826","article-title":"Growth Retardation in Non-steroid Treated Juvenile Rheumatoid Arthritis","volume":"26","author":"Polito","year":"1997","journal-title":"Scand. J. Rheumatol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.semarthrit.2017.11.002","article-title":"Growth patterns in early juvenile idiopathic arthritis: Results from the Childhood Arthritis Prospective Study (CAPS)","volume":"48","author":"McErlane","year":"2017","journal-title":"Semin. Arthritis Rheum."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Patti, A., Maggio, M.C., Corsello, G., Messina, G., Iovane, A., and Palma, A. (2017). Evaluation of Fitness and the Balance Levels of Children with a Diagnosis of Juvenile Idiopathic Arthritis: A Pilot Study. Int. J. Environ. Res. Public Health, 14.","DOI":"10.3390\/ijerph14070806"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"3505","DOI":"10.1093\/rheumatology\/keaa240","article-title":"Development and initial validation of a composite disease activity score for systemic juvenile idiopathic arthritis","volume":"59","author":"Tibaldi","year":"2020","journal-title":"Rheumatology"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"5236","DOI":"10.1210\/endo.137.12.8940340","article-title":"Regulation of hypothalamic somatostatin, growth hormone-releasing hormone, and growth hormone receptor messenger ribonucleic acid by glucocorticoids","volume":"137","author":"Lago","year":"1996","journal-title":"Endocrinology"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1483","DOI":"10.1007\/s00296-014-3022-2","article-title":"Growth abnormalities in children and adolescents with juvenile idiopathic arthritis","volume":"34","author":"Bechtold","year":"2014","journal-title":"Rheumatol. Int."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.mce.2012.08.001","article-title":"The hidden but positive role for glucocorticoids in the regulation of growth hormone-producing cells","volume":"363","author":"Vakili","year":"2012","journal-title":"Mol. Cell. Endocrinol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1111\/j.1365-2265.2007.02763.x","article-title":"Modulation of glucocorticoid metabolism by the growth hormone? IGF-1 axis","volume":"66","author":"Agha","year":"2007","journal-title":"Clin. Endocrinol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1159\/000125315","article-title":"Dual and Selective Actions of Glucocorticoids upon Basal and Stimulated Growth Hormone Release in Man","volume":"51","author":"Burguera","year":"1990","journal-title":"Neuroendocrinology"},{"key":"ref_40","first-page":"717","article-title":"Pathophysiology of the Neuroregulation of Growth Hormone Secretion in Experimental Animals and the Human","volume":"19","author":"Giustina","year":"1998","journal-title":"Endocr. Rev."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1007\/s40618-022-01880-w","article-title":"Appropriate management of growth hormone deficiency during the age of transition: An Italian Delphi consensus statement","volume":"46","author":"Cappa","year":"2022","journal-title":"J. Endocrinol. Investig."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1159\/000345354","article-title":"Impaired GH Secretion in Patients with SHOX Deficiency and Efficacy of Recombinant Human GH Therapy","volume":"78","author":"Iughetti","year":"2012","journal-title":"Horm. Res. Paediatr."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1053\/j.ajkd.2017.07.019","article-title":"KDOQI US Commentary on the 2017 KDIGO Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease\u2013Mineral and Bone Disorder (CKD-MBD)","volume":"70","author":"Isakova","year":"2017","journal-title":"Am. J. Kidney Dis."},{"key":"ref_44","first-page":"174","article-title":"Overview of pediatric bone problems and related osteoporosis","volume":"12","author":"Zhang","year":"2012","journal-title":"J. Musculoskelet. Neuronal Interact."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1319","DOI":"10.1007\/s00198-007-0394-0","article-title":"Glucocorticoid-induced osteoporosis: Pathophysiology and therapy","volume":"18","author":"Canalis","year":"2007","journal-title":"Osteoporos. Int."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"918","DOI":"10.3389\/fphar.2019.00918","article-title":"Anakinra Drug Retention Rate and Predictive Factors of Long-Term Response in Systemic Juvenile Idiopathic Arthritis and Adult Onset Still Disease","volume":"10","author":"Sota","year":"2019","journal-title":"Front. Pharmacol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1526","DOI":"10.3389\/fphar.2018.01526","article-title":"Drug Retention Rate and Predictive Factors of Drug Survival for Interleukin-1 Inhibitors in Systemic Juvenile Idiopathic Arthritis","volume":"9","author":"Sota","year":"2019","journal-title":"Front. Pharmacol."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"49 Bianchi, M.L., Cimaz, R., Galbiati, E., Corona, F., Cherubini, R., and Bardare, M. (1999). Bone Mass Change During Methotrexate Treatment in Patients with Juvenile Rheumatoid Arthritis. Osteoporos. Int., 10, 20\u201325.","DOI":"10.1007\/s001980050189"},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Sawhney, S., and Aggarwal, A. (2017). Pediatric Rheumatology, Springer.","DOI":"10.1007\/978-981-10-1750-6"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1007\/s11926-012-0315-x","article-title":"Long-Term Bone Health in Glucocorticoid-Treated Children with Rheumatic Diseases","volume":"15","author":"Lang","year":"2013","journal-title":"Curr. Rheumatol. Rep."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1177\/0961203307079040","article-title":"Bone status in juvenile systemic lupus erythematosus","volume":"16","author":"Lilleby","year":"2007","journal-title":"Lupus"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1007\/s40272-017-0219-3","article-title":"Protecting Bone Health in Pediatric Rheumatic Diseases: Pharmacological Considerations","volume":"19","author":"Zhang","year":"2017","journal-title":"Pediatr. Drugs"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1053\/berh.2002.0236","article-title":"Osteoporosis in childhood rheumatic diseases: Prevention and therapy","volume":"16","author":"Cimaz","year":"2002","journal-title":"Best Pract. Res. Clin. Rheumatol."},{"key":"ref_54","first-page":"e5195","article-title":"Osteoporotic Fractures and Vertebral Body Reshaping in Children with Glucocorticoid-Treated Rheumatic Disorders","volume":"106","author":"Ward","year":"2021","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1383","DOI":"10.1093\/rheumatology\/39.12.1383","article-title":"Oral corticosteroids and fracture risk: Relationship to daily and cumulative doses","volume":"39","author":"Leufkens","year":"2000","journal-title":"Rheumatology"},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Di Marcello, F., Di Donato, G., D\u2019angelo, D.M., Breda, L., and Chiarelli, F. (2022). Bone Health in Children with Rheumatic Disorders: Focus on Molecular Mechanisms, Diagnosis, and Management. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms23105725"},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Kim, J.-W., Jung, J.-Y., Kim, H.-A., and Suh, C.-H. (2021). Anti-Inflammatory Effects of Low-Dose Glucocorticoids Compensate for Their Detrimental Effects on Bone Mineral Density in Patients with Rheumatoid Arthritis. J. Clin. Med., 10.","DOI":"10.3390\/jcm10132944"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1313","DOI":"10.1136\/annrheumdis-2022-222339","article-title":"Optimising both disease control and glucocorticoid dosing is essential for bone protection in patients with rheumatic disease","volume":"81","author":"Wiebe","year":"2022","journal-title":"Ann. Rheum. Dis."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1935","DOI":"10.3899\/jrheum.091241","article-title":"Cross-sectional and Longitudinal Evaluation of Bone Mass in Children and Young Adults with Juvenile Idiopathic Arthritis: The Role of Bone Mass Determinants in a Large Cohort of Patients","volume":"37","author":"Stagi","year":"2010","journal-title":"J. Rheumatol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1392","DOI":"10.1177\/0961203314543916","article-title":"Comparison of bone mass and quality determinants in adolescents and young adults with juvenile systemic lupus erythematosus (JSLE) and juvenile idiopathic arthritis (JIA)","volume":"23","author":"Stagi","year":"2014","journal-title":"Lupus"},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Brusa, J., Maggio, M.C., Giustino, V., Thomas, E., Zangla, D., Iovane, A., Palma, A., Corsello, G., Messina, G., and Bellafiore, M. (2020). Upper and Lower Limb Strength and Body Posture in Children with Congenital Hypothyroidism: An Observational Case-Control Study. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17134830"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1002\/cam4.193","article-title":"Evaluation of fitness levels of children with a diagnosis of acute leukemia and lymphoma after completion of chemotherapy and autologous hematopoietic stem cell transplantation","volume":"3","author":"Bianco","year":"2014","journal-title":"Cancer Med."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1097\/01.bor.0000231913.32364.32","article-title":"Osteoclast precursors: Cytokine-stimulated immunomodulators of inflammatory bone disease","volume":"18","author":"Boyce","year":"2006","journal-title":"Curr. Opin. Rheumatol."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1359\/jbmr.1998.13.3.393","article-title":"IL-6 Mediates the Effects of IL-1 or TNF, but Not PTHrP or 1,25(OH)2D3, on Osteoclast-like Cell Formation in Normal Human Bone Marrow Cultures","volume":"13","author":"Devlin","year":"1998","journal-title":"J. Bone Miner. Res."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"4514","DOI":"10.1210\/jc.2007-0646","article-title":"CLINICAL Review: The role of receptor activator of nuclear factor-kappaB (RANK)\/RANK ligand\/osteoprotegerin: Clinical implications","volume":"92","author":"Vega","year":"2007","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1146\/annurev.immunol.021908.132710","article-title":"IL-17 and Th17 cells","volume":"27","author":"Korn","year":"2009","journal-title":"Annu. Rev. Immunol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1550","DOI":"10.1093\/rheumatology\/keq123","article-title":"Etanercept improves linear growth and bone mass acquisition in MTX-resistant polyarticular-course juvenile idiopathic arthritis","volume":"49","author":"Billiau","year":"2010","journal-title":"Rheumatology"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"894S","DOI":"10.1177\/1947603520961173","article-title":"The Assessment of Steroid Injections as a Potential Risk Factor for Osteochondral Lesions in Children with Juvenile Idiopathic Arthritis","volume":"13","author":"Heidt","year":"2020","journal-title":"Cartilage"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1007\/s00296-014-3108-x","article-title":"Frequency of joint involvement in juvenile idiopathic arthritis during a 5-year follow-up of newly diagnosed patients: Implications for MR imaging as outcome measure","volume":"35","author":"Hemke","year":"2014","journal-title":"Rheumatol. Int."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"e507","DOI":"10.1016\/S2665-9913(21)00086-2","article-title":"Musculoskeletal manifestations of childhood cancer and differential diagnosis with juvenile idiopathic arthritis (ONCOREUM): A multicentre, cross-sectional study","volume":"3","author":"Civino","year":"2021","journal-title":"Lancet Rheumatol."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"e526","DOI":"10.1002\/ctm2.526","article-title":"Glucocorticoid-induced osteonecrosis in systemic lupus erythematosus patients","volume":"11","author":"Kaneko","year":"2021","journal-title":"Clin. Transl. Med."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1002\/art.30102","article-title":"Age at time of corticosteroid administration is a risk factor for osteonecrosis in pediatric patients with systemic lupus erythematosu: A prospective MagnetIc resonance imaging study","volume":"62","author":"Nakamura","year":"2010","journal-title":"Arthritis Rheum."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"503","DOI":"10.3389\/fphys.2016.00503","article-title":"Expression of Steroid Receptors in Ameloblasts during Amelogenesis in Rat Incisors","volume":"7","author":"Houari","year":"2016","journal-title":"Front. Physiol."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"343","DOI":"10.3389\/fphys.2017.00343","article-title":"Disruption of Steroid Axis, a New Paradigm for Molar Incisor Hypomineralization (MIH)","volume":"8","author":"Babajko","year":"2017","journal-title":"Front. Physiol."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1007\/s11547-019-01038-4","article-title":"National guidelines for dental diagnostic imaging in the developmental age","volume":"124","author":"Firetto","year":"2019","journal-title":"Radiol. Med."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"383","DOI":"10.4274\/jcrpe.galenos.2020.2019.0220","article-title":"Different Potent Glucocorticoids, Different Routes of Exposure but the Same Result: Iatrogenic Cushing\u2019s Syndrome and Adrenal Insufficiency","volume":"12","year":"2020","journal-title":"J. Clin. Res. Pediatr. Endocrinol."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1590\/S0100-879X2000001000001","article-title":"Role of the hypothalamic pituitary adrenal axis in the control of the response to stress and infection","volume":"33","author":"McCann","year":"2000","journal-title":"Braz. J. Med. Biol. Res."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1196\/annals.1366.027","article-title":"The Role of Toll-like Receptors in the Immune-Adrenal Crosstalk","volume":"1088","author":"Bornstein","year":"2006","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1038\/nri.2017.1","article-title":"Immune regulation by glucocorticoids","volume":"17","author":"Cain","year":"2017","journal-title":"Nat. Rev. Immunol."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/j.intimp.2016.12.015","article-title":"CD14++ CD16\u2212 monocytes are the main source of 11\u03b2-HSD type 1 after IL-4 stimulation","volume":"43","author":"Kunnathully","year":"2017","journal-title":"Int. Immunopharmacol."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1042\/cs0940557","article-title":"Anti-inflammatory Actions of Glucocorticoids: Molecular Mechanisms","volume":"94","author":"Barnes","year":"1998","journal-title":"Clin. Sci."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1182\/blood-2002-02-0538","article-title":"Synthesis of glucocorticoid-induced leucine zipper (GILZ) by macrophages: An anti-inflammatory and immunosuppressive mechanism shared by glucocorticoids and IL-10","volume":"101","author":"Berrebi","year":"2003","journal-title":"Blood"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/j.jaut.2018.05.010","article-title":"11 Beta-hydroxysteroid dehydrogenase type 1 regulates synovitis, joint destruction, and systemic bone loss in chronic polyarthritis","volume":"92","author":"Hardy","year":"2018","journal-title":"J. Autoimmun."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"5134","DOI":"10.1182\/blood-2008-11-190769","article-title":"Cortisol and epinephrine control opposing circadian rhythms in T cell subsets","volume":"113","author":"Dimitrov","year":"2009","journal-title":"Blood"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"1557","DOI":"10.4049\/jimmunol.147.5.1557","article-title":"Hydrocortisone and IL-4 induce IgE isotype switching in human B cells","volume":"147","author":"Jabara","year":"1991","journal-title":"J. Immunol."},{"key":"ref_86","first-page":"10","article-title":"The effect of stress on the defense systems","volume":"3","year":"2010","journal-title":"J. Med. Life"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"20160046","DOI":"10.1515\/hmbci-2016-0046","article-title":"Differential modulation of innate immune response by epinephrine and estradiol","volume":"30","author":"Margaryan","year":"2017","journal-title":"Horm. Mol. Biol. Clin. Investig."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"1345","DOI":"10.1016\/j.psyneuen.2012.05.008","article-title":"Stress-induced redistribution of immune cells\u2014From barracks to boulevards to battlefields: A tale of three hormones\u2014Curt Richter Award Winner","volume":"37","author":"Dhabhar","year":"2012","journal-title":"Psychoneuroendocrinology"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1111\/j.1749-6632.2001.tb05826.x","article-title":"The role of cytokines in physiological sleep regulation","volume":"933","author":"Krueger","year":"2001","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1186\/s13075-020-02167-2","article-title":"Opportunistic infections in immunosuppressed patients with juvenile idiopathic arthritis: Analysis by the Pharmachild Safety Adjudication Committee","volume":"22","author":"Giancane","year":"2020","journal-title":"Arthritis Res. Ther."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1186\/s13052-019-0766-z","article-title":"FMF is not always \u201cfever\u201d: From clinical presentation to \u201ctreat to target\u201d","volume":"46","author":"Maggio","year":"2020","journal-title":"Ital. J. Pediatr."}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/24\/17\/13192\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:38:42Z","timestamp":1760128722000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/24\/17\/13192"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,25]]},"references-count":91,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2023,9]]}},"alternative-id":["ijms241713192"],"URL":"https:\/\/doi.org\/10.3390\/ijms241713192","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,25]]}}}