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Rheumatoid arthritis (RA) strikes three times more women than men and researchers in Europe may have found a clue.   Scientists at the Arthritis Research UK Epidemiology Unit at the U of Manchester have discovered 14 new genes that can lead to RA, adding to the 32 other genes that have already been identified.  The researchers latest study published in Nature Genetics, has reported genes that are specific to the female X-chromosome.  According to Professor Alan Silman, medical director at the Research Unit, “This is the first time that a genetic association has been established between RA and the X chromosome.”
 

When people with Type 2 diabetes are diagnosed with cancer – a disease for which they are at higher risk – they ignore their diabetes care to focus on cancer treatment, according to new Northwestern Medicine® research. But uncontrolled high blood sugar is more likely to kill them and impair their immune system’s ability to fight cancer.
However, people with Type 2 diabetes who received diabetes education after a cancer diagnosis were more likely to take care of their blood sugar. As a result, they had fewer visits to the emergency room, fewer hospital admissions, lower health care costs, and they tested their blood sugar levels more often than people who didn’t have the education. They also had more hemoglobin a-1c level tests at their doctor’s offices. The latter is a critical marker of how well someone has managed their diabetes and blood sugar over the last three months.
“People with diabetes hear cancer and they think that it is a death sentence, so who cares about diabetes at this point?” said June McKoy, MD, director of geriatric oncology at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. “But if they’re not careful, it’s the diabetes that will take them out of this world, not the cancer. That’s why this education is so critical when cancer comes on board. Patients must take care of both illnesses.”
McKoy is the senior author of the study recently published in the journal Population Health Management. Lauren Irizarry, a fourth-year medical student at Feinberg, is the lead author.
Uncontrolled high blood sugar can result in kidney damage and failure as well as blindness and amputation of the feet as blood vessels are damaged by excess sugar. In addition, Type 2 diabetes dampens the immune system and hampers the body’s ability to fight cancer.    People with diabetes have a higher incidence of liver cancer, pancreatic cancer, colon cancer, breast cancer, bladder cancer, and endometrial cancer.
Source:   Northwestern NewCenter
 

In January 2013, the American College of Obstetricians and Gynecologists (ACOG), which is the nation’s leading group in the field of obstetrics and gynecology, released an opinion on a lesser known form of abuse called reproductive coercion. Reproductive coercion occurs whenever a woman’s partner tries to stop her from making her own decisions regarding pregnancy. This includes pressuring a woman to have an abortion she doesn’t want, using threats to stop a woman from having an abortion she does want, and attempting to impregnate a woman against her will. This can include a man hiding his partner’s birth control pills, removing a condom in the middle of sex, or even removing a woman’s intrauterine device (IUD) or other internal contraceptive.
Rebekah Gee, an obstetrician and gynecologist who has studied this issue, believes that for men, reproductive coercion is often, “about taking away choices, taking away freedom, control and self-esteem.” She also points out that a man may attempt to get his partner pregnant to tie her to him, and prevent her from leaving him.
Researchers believe that this form of abuse, also called “birth control sabotage,” is more common among women who are abused by their partners in other ways. One study indicates that 25% of teenage girls and 15% of women with abusive partners reported experiencing reproductive coercion. Although researchers involved in the ACOG report are unsure exactly how prevalent this form of abuse is, they believe it is common enough that physicians and other healthcare providers should screen women and check for signs of reproductive coercion during routine visits.
If physicians do not ask questions, women who undergo abuse may not realize that something can be done to improve or resolve the situation they are in. Doctors can take direct steps to help these women by providing difficult to detect birth control, such as IUDs with shortened strings, or emergency contraceptives in unmarked packaging. Additionally, they can direct women to assistance hotlines or agencies, such as the National Domestic Violence Hotline. Simply providing information can also make a difference. In one small study, women in clinics were given small cards with information and a questionnaire about reproductive coercion. Reports of coercion dropped 71% among women who received this information.
While increasing awareness about reproductive coercion and providing immediate help to women experiencing this type of abuse is critical, implementing education and prevention programs will be an important step in stopping reproductive coercion in the future.
Source: Painter, Kim. “Abusive Partners can Sabotage Contraception.” USA Today. 23 January 2013.

More intense sunlight exposure was linked with a decreased incidence of rheumatoid arthritis (RA) among women in the original Nurses’ Health Study (NHS), although the more common use of sunscreen likely weakened the association in a later cohort, researchers found.   Rheumatoid arthritis, or RA, is a form of inflammatory arthritis and an autoimmune disease. For reasons no one fully understands, in rheumatoid arthritis, the immune system – which is designed to protect our health by attacking foreign cells such as viruses and bacteria – instead attacks the body’s own tissues, specifically the synovium, a thin membrane that lines the joints. As a result of the attack, fluid builds up in the joints, causing pain in the joints and inflammation that’s systemic – meaning it can occur throughout the body.
In the original Nurses’ Health Study, which began in 1976, women (ages 30 to 55) living in states with the highest ultraviolet B (UVB) intensity had a 21% lower risk for RA compared with those living in states with low UVB levels according to Elizabeth Arkema, PhD, and colleagues from Harvard University.
But in NHSII, initiated in 1989 in women ages 25 to 42, no significantly lower risk was seen, the researchers reported online in Annals of the Rheumatic Diseases.
“The later birth cohort of NHSII participants (born between 1946 and 1964) were more likely aware of the dangers of sun exposure and, perhaps, had more sun-protective behavior, making residential UVB not as good a proxy for actual sun exposure in NHSII,” they suggested.
Epidemiologic studies have found a correlation between an increased incidence of RA and other autoimmune diseases with higher latitude (more northern) areas  of residence.  In addition, experimental studies have demonstrated that UVB may suppress the immune system (which overacts in RA).  Exposure to UVB also increases vitamin D synthesis in the skin, which, in turn, has altering effects on the immune system properties.
UVB flux is a measure that reflects exposure intensity based on altitude, latitude, and typical cloud cover patterns, and is expressed in Robertson-Berger units. This measure shows considerable variability in the U.S., ranging from 196 R-B units in sunny states such as Arizona and Hawaii to only 93 units in Oregon and Alaska.
Information on residence, health, diet, and lifestyle was acquired every 2 years from participants in both cohorts.
Similar findings of decreased risk for high exposure in NHS though not in NHSII were seen both for exposure levels at birth and at age 15.  It thus remains unclear if the important window for UVB exposure is in childhood or adulthood. Further analyses found no significant heterogeneity according to skin type, vitamin D intake, or physical activity and body mass index.
These findings add to the increasing evidence that more intense sun exposure lowers the risk of RA, the researchers stated.  “The mechanisms are not yet understood, but could be mediated by cutaneous production of vitamin D and attenuated by use of sunscreen or sun avoidant behavior,” Arkema and colleagues wrote.  They called for additional research to explore UVB dose intensity and timing of exposure.
EDITOR’s NOTE:   While the link to skin cancer and UVB exposure is well known, the increased use of sunscreen raises other health concerns that may require new approaches to find a “balance” so the benefits of  a little sunshine are not totally lost.
Source reference:
Arkema E, et al “Exposure to ultraviolent-B and risk of developing rheumatoid arthritis among women in the Nurses’ Health Study” Ann Rheum Dis 2013; DOI: 10.1136/annrheumdis-2012-202302.