Email updates

Keep up to date with the latest news and content from Arthritis Research & Therapy and BioMed Central.

Highly Accessed Open Badges Review

Neural immune pathways and their connection to inflammatory diseases

Farideh Eskandari, Jeanette I Webster and Esther M Sternberg*

Author Affiliations

Section on Neuroendocrine Immunology and Behavior, NIMH/NIH, Bethesda, MD, USA

For all author emails, please log on.

Arthritis Res Ther 2003, 5:251-265  doi:10.1186/ar1002

Published: 23 September 2003


Inflammation and inflammatory responses are modulated by a bidirectional communication between the neuroendocrine and immune system. Many lines of research have established the numerous routes by which the immune system and the central nervous system (CNS) communicate. The CNS signals the immune system through hormonal pathways, including the hypothalamic–pituitary–adrenal axis and the hormones of the neuroendocrine stress response, and through neuronal pathways, including the autonomic nervous system. The hypothalamic–pituitary–gonadal axis and sex hormones also have an important immunoregulatory role. The immune system signals the CNS through immune mediators and cytokines that can cross the blood–brain barrier, or signal indirectly through the vagus nerve or second messengers. Neuroendocrine regulation of immune function is essential for survival during stress or infection and to modulate immune responses in inflammatory disease. This review discusses neuroimmune interactions and evidence for the role of such neural immune regulation of inflammation, rather than a discussion of the individual inflammatory mediators, in rheumatoid arthritis.

cytokine; hypothalamic–pituitary–adrenal axis; immune; inflammatory; neural; rheumatoid arthritis