To "sun" or not to "sun"--is there a logical balance?
Posted by on February 12, 2013 - 2:50pm

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.

 

Sjogren's syndrome more common in women
Posted by on March 29, 2012 - 7:17am

If your eyes and mouth feel as dry as a desert, there are many possible causes, such as bad air quality and certain medications. But if you have long-lasting, uncomfortable dryness in your eyes and mouth, along with fatigue or pain and swelling in some of your joints, you may have a condition called Sjögren’s syndrome.

Sjögren’s (pronounced SHOW-grins) syndrome affects as many as 4 million people nationwide. Men and women of all ages can develop the condition, but it most often shows up in women in their 50s and 60s. The disorder is 9 times more common in women than in men.

Sjögren’s syndrome arises when the body’s immune system, which ordinarily attacks invading bacteria and viruses, starts killing off the body’s own moisture-producing cells. The condition can occur on its own or alongside other diseases, such as lupus or rheumatoid arthritis, in which the immune system mistakenly attacks parts of the body.

In some cases of Sjögren’s, the immune system attacks several parts of the body, including the eyes, mouth, joints and internal organs. Because the disorder has such varying effects, diagnosing Sjögren’s syndrome can take a long time.  “The average time to diagnose Sjögren’s is about 7 years from the first symptoms, because the symptoms can be very subtle,” says Dr. Gabor Illei, head of the Sjögren’s Clinic on the NIH campus in Bethesda, Maryland.

Physicians use several tests to make a diagnosis. These include measuring tear and saliva flow, blood tests, and biopsies. In the biopsy test, a surgeon removes a small saliva-producing gland from the lip and looks at it under a microscope. The blood tests and biopsies let physicians know if the body’s immune system is attacking saliva-producing cells.

Since so many of the body’s systems can be affected, people with Sjögren’s syndrome often need to see several specialists. These can include an ophthalmologist for the eyes, an oral disease specialist or a dentist who has experience with dry mouth, and a rheumatologist, who can manage and coordinate care.

Many treatments for Sjögren’s syndrome aim to relieve the symptoms of dryness. For patients with mild dryness, over-the-counter artificial tears can help with dry eye. Sips of water and sugar-free candies can help with dry mouth. Because saliva usually protects teeth from decay, people with dry mouth need to be careful to avoid sugary candies, and to take care of their teeth.

For more severe symptoms, several medications are available or in development. Two current drugs boost saliva production, and another can increase tear production. Some promising new drugs are being tested to treat symptoms that affect other parts of the body.   The Sjögren’s Clinic at NIH has several ongoing clinical trials under way. “We do clinical studies. Some are just observational, so we follow the disease over time. " If you have Sjögren’s syndrome and are interested in participating in a clinical trial, learn more about trials near you at http://clinicaltrials.gov.

Sjögren’s syndrome is a chronic condition, and there is no cure. However, treatment can improve symptoms and prevent problems like cavities and eye infections. Sjögren’s syndrome can be complex, but a primary care doctor or rheumatologist can help you manage your treatments and all the hurdles along the way.

Source:  NIH

An Estimated 90% of People Diagnosed with Lupus are Women
Posted by on May 27, 2011 - 7:48am

Classic Butterfly Rash

Yet many people do not know what lupus is and how serious it can be.  Lupus is a chronic autoimmune disease that can affect various parts of the body, including the skin, joints, heart, lungs, blood, kidneys, and brain.  Normally the body's immune system makes proteins called antibodies that protect the body against viruses, bacteria and other foreign invaders. These foreign invaders are called antigens.

In an autoimmune disorder like lupus, the immune system cannot tell the difference between foreign substances and its own cells and tissues. The immune system then makes antibodies that, simply put, attack the body itself. This causes inflammation, pain and damage to various organs.

Inflammation is considered the primary feature of lupus. Inflammation causes pain, heat, redness, swelling and loss of function, inside and/or outside the body.   For many people, lupus can be a manageable disease with relatively mild symptoms. For others, it may cause serious and even life-threatening problems.

Sometimes people with lupus experience a "flare." This occurs when some symptoms appear or get worse for short periods then disappear or get better. Even if you take medicine for lupus, you may find that there are times when the symptoms become worse. Learning to recognize that a flare is coming can help you take steps to cope with it. Many people feel very tired or have pain, a rash, a fever, stomach discomfort, headache, or dizziness just before a flare.  It is not infectious, rare or cancerous.

It’s estimated that more than 16,000 Americans develop lupus each year.  We do not know the cause, but scientists believe some people are predisposed to the disease.  In the United States, lupus is more common among African Americans, Asians, Hispanics, and Native Americans than Caucasians.

Symptoms of lupus include:

  • Muscle and joint pain
  • Fever greater that 100∘F
  • Prolonged or extreme fatigue
  • Anemia (low red blood cell count)
  • Kidney problems
  • Chest pain, especially when breathing deeply
  • Rashes especially on the face
  • Light sensitivity
  • Hair loss
  • Abnormal blood clotting
  • Eye problems (dry eyes, inflammation, rashes0
  • Seizures
  • Mouth or nose ulcers

To learn more about lupus visit:  Could I have Lupus. If you want to test your knowledge on lupus, take this QUIZ.