Mechanism Behind Autoimmune Diseases Found

A mechanism that could result in autoimmune diseases such as rheumatoid arthritis, lupus or diabetes has been identified by researchers at National Jewish Medical and Research Center.

They found that a form of potentially harmful immune system B cells circulating in the body are not permanently inactivated as previously believed. It turns out these harmful B cells can reactivate and launch attacks on the body's own tissue.

"Keeping self-reactive B cells in a quiescent state is crucial for the prevention of autoimmunity. Our findings show how these cells can be reactivated and suggest lines of research that may lead to therapies for autoimmune diseases," research leader John Cambier, chairman of the integrated department of immunology at National Jewish and the University of Colorado Health Sciences Center, said in a prepared statement.

Normally, these dangerous B cells are kept in a state of suspended animation, which prevents them from attacking body tissue. However, this study suggests that an active bacterial infection may draw self-reactive B cells to lymphoid organs -- such as the tonsils or lymph nodes -- where a strong immune/inflammatory response to the infection causes the cells to reawaken and trigger an autoimmune disease.

The findings were published online in Nature Immunology.

"There have been reports linking the onset of autoimmunity with a preceding bacterial infection," study author Stephen Gauld, a postdoctoral fellow in Cambier's lab, said in a prepared statement.

"We are now conducting experiments to determine the role of pro-inflammatory or bacterial products in the loss of B-cell anergy (suspended animation). We are also seeking to better understand the intracellular events that lead to anergy and its loss. Either of these lines of research could uncover potential targets for autoimmune therapy," Gauld said.

More information

The U.S. National Women's Health Information Center has more about autoimmune diseases.

Most Asthmatics Can Boost Symptom Control

When it comes to asthma, experts say there's a huge knowledge gap between what patients believe they must endure as part of their illness and what they spare themselves by managing their disease properly.

"We have known for a long time that asthma can be controlled better, that it is not being controlled as well as it can be, and that we ought to do something about it," said Dr. Norman Edelman, a professor of medicine at the State University of New York at Stony Brook and a medical consultant to the American Lung Association.

Approximately 20 million Americans have asthma and at least half are not as controlled as they could be -- suffering needlessly from interrupted sleep, lost days at work or school, and inability to exercise, Edelman said.

A recent poll taken by the Asthma and Allergy Foundation of America (AAFA) found that 88 percent of nearly 600 adults who have asthma reported managing their symptoms well. But that may not be the case: In that same group, 61 percent said they had to catch their breath while running up the stairs, 48 percent have been woken in the night as a result of asthma symptoms and 50 percent have had to stop exercising in the middle of their regimens.

Among 118 respondents whose children have asthma, 89 percent felt their children's symptoms were being well-controlled, yet half of the children had missed days of school and or work, half were unable to complete their exercise programs, and 45 percent were awakened in the night because of asthma symptoms.

"This was an interesting study of perception versus reality," said AAFA spokesman Mike Tringale. "These people have learned to live with compromised lives."

He added, "Now, however, because of better understanding of the disease, better preventive education and better medicines, most people with asthma don't have to have any symptoms."

The implications of poorly managed asthma are numerous, including physical problems such as weight gain from not exercising. "Weight gain is terrible for asthma, because it exacerbates the symptoms," he said.

And there are more subtle psychological changes.

"People's personalities are affected. Even though you are going about your daily activities, like going to work, you are still disabled because you are not functioning at your maximum. It changes who you are," Edelman said.

To close the knowledge gap, both the American Lung Association and AAFA have started programs to alert asthma sufferers that most can control their asthma more effectively.

Last spring the American Lung Association introduced a five-question online test on its Web site for asthma sufferers over the age of 12. Questions include asking if and how seriously within the last four weeks asthma symptoms prevented asthmatics from completing work at school or in the office, if those with asthma are kept awake at night because of their illness and how often asthmatics have experienced shortness of breath.

"About 100,000 people have taken the test online, and two-thirds of them have found that they don't have their asthma under control," said Edelman.

The test's success has spurred the Lung Association to develop another quiz designed for children under 12, to be answered by their parents.

The AAFA's program called Sleep Work Play also helps asthma patients better recognize their symptoms so they can talk to their doctors about controlling them.

"People haven't been talking in the same language. Doctors don't probe deeply enough in patients' symptoms, parents don't question their kids," said AAFA's Tringale.

The program includes a Web site questionnaire that asks asthma patients about their sleep, work and play habits. It also encourages users to take the completed questionnaire to their doctor, so that the two of them can discuss how to better manage asthma symptoms.

The questions -- for example, "Do you have to stop and do things differently because of your asthma? Please be specific: even little things like walking through a park, petting a dog, going on vacation, etc." -- help people to think about how asthma symptoms are really affecting their lives, Tringale said.

More information

For adults, the asthma control questionnaire can be found at the American Lung Association. The kids-oriented quiz is at the Asthma and Allergy Foundation of America.

Side Effects Trouble Breast Cancer Patients on Hormone Therapy

Many breast cancer patients who are using hormone therapies like tamoxifen to cut the risk of recurrence prefer pills over injections, given a choice.

But if injections could reduce hot flashes, a side effect of such treatments, more than 60 percent of the women surveyed said they would choose the shots.

And if the shots would better control the cancer than the pills do, 74.5 percent would pick the injections.

Those are the findings of a British study published in the Oct. 20 edition of the Annals of Oncology, in which the team also found that women often skipped their hormone treatments in pill form.

"The take-home message is that unless we find some way of helping women with breast cancer deal effectively with their hot flashes and other menopausal side effects, then optimal doses of anti-cancer drugs may not be reaching the patients," said Lesley Fallowfield, lead author of the study and Cancer Research UK Professor of Psychosocial Oncology at Brighton & Sussex Medical School at the University of Sussex.

In the study, Fallowfield's team interviewed 208 women with early or advanced stage breast cancer who had been diagnosed at least two years before. When they were asked which medicine form they would prefer if daily tablets or a double injection once a month were equally effective and had equal side effects, 63 percent picked pills, 24.5 percent chose injections and 12.5 percent had no preference.

But when presented with a hypothetical scenario in which the injection of hormone treatments produced fewer hot flashes, the responses changed, with only 27.4 percent choosing pills and 60.6 percent picking the shots. Another 12 percent had no preference.

And when presented a scenario in which the shots better controlled the cancer, even more, 74.5 percent, chose the injections.

Those who picked pills in the initial scenario said they were more convenient; and some said they disliked needles. Those who preferred shots said they were more convenient and it was easier to comply with the therapy.

But Fallowfield and her team also found that taking the pills as prescribed didn't always happen. Of the women who admitted they skipped their pills, 48.7 percent said they sometimes forgot, and 13.1 percent admitted they deliberately didn't take their pills some of the time.

The fact that women sometimes missed taking the pills was no surprise to Dr. Patricia Ganz, director of cancer prevention and control research at the University of California, Los Angeles Jonsson Comprehensive Cancer Center. "Non-adherence to medication is common," she said, although "women with breast cancer are more motivated [than some others] to take their medication."

But the degree of non-adherence was startling to Fallowfield. "We were very surprised to see the level of non-adherence to tablet taking in women with life-threatening disease," she said, "and the fact that 25 percent preferred injections to ensure compliance."

Prescribing hormone treatment in tablet form rather than shots is standard practice, Ganz said. "Right now there is no injectable that does not cause hot flashes," she said.

Ganz also wondered if the motivation for the study, funded by pharmaceutical company AstraZeneca -- maker of anastrozole, one of the medications prescribed for women after breast cancer -- was to see if there was a market to develop such an injectable drug.

AstraZeneca spokeswoman Katie Neff said the company is not developing such a drug at this time.

More information

To learn more about breast cancer, visit the American Cancer Society.

Navigating the Individual Health Insurance Market

If you're unemployed or self-employed or if you work for a small business that doesn't offer health insurance benefits, buying a health plan on your own may seem prohibitively expensive.

But it's worth investigating the options in your state, insurance brokers say.

"It's always better to be covered for something than nothing," said Thomas H. Harte, president of Landmark Benefits in Hampstead, N.H.

The cost may depend on what a person is looking for, he said. There are a number of variables to consider, including the monthly premium you'll pay, co-payments you'll incur on services and drugs, and the types of benefits a plan will cover.

Premiums vary from state to state and may hinge on the type of insurance market reforms a state has implemented, explained Harte, who serves on the National Association of Health Underwriters' legislative council. In New Hampshire, for example, a healthy person will pay less than a comparable individual in Massachusetts. The difference is that New Hampshire allows insurers to adjust premiums based on an individual's health status and use of health services, while Massachusetts does not, he said.

Premiums are generally higher in the New England and Mid-Atlantic regions of the country, according to a report by the Henry J. Kaiser Family Foundation and eHealthInsurance.com, an online health insurance referral site.

Nationally, the report said, older purchasers generally pay higher premiums than younger purchasers, reflecting the higher health-care costs that people typically incur as they get older.

In addition to premiums, individual health insurer buyers should consider their out-of-pocket exposure. Deductibles for single and family policies vary widely, from less than $500 to more than $3,000, the Kaiser/eHealthInsurance report showed. Co-payments for physician office visits differ, too. About one half of single purchasers choose plans with co-payments of less than $20, the report said.

Consumers also need to learn about any exclusions and limitations that may affect their out-of-pocket costs, Harte advised. A health plan with a generic drugs-only policy, for example, may be a poor fit for a person who takes a brand-name medication with no generic equivalent. He or she may qualify to receive the insurer's negotiated discount at the pharmacy counter, but the money to pay for that medicine would come from the health plan member's own pocket.

Individuals who are willing to assume risk for routine medical expenses in order to lower their health insurance premium might want to consider a "high-deductible health plan." With the exception of some preventive care services, these plans don't begin paying for medical care until the policyholder has met a higher-than-usual deductible.

"You have to talk to your insurance broker or agent to determine if it will be a cost-effective decision for you," Harte noted.

Then comes the application process. Whether you are seeking insurance for yourself or your family, you'll need to complete the insurer's health questionnaire, which will ask about your use of medical services say, over the past year, as well as your medical history.

It's in your best interest to answer truthfully, Harte advised. If you don't, your insurer may terminate your policy retroactively or boost your premium.

As a safeguard, more than half of all states have high-risk pools to insure individuals who are denied private coverage, according to the National Conference of State Legislatures. These pools typically offer coverage similar to what's available through private insurers, but it's always more expensive.

More information

Visit the National Association of Health Underwriters for tips on buying health insurance.