Lupus flares could be linked to environmental factors



The researchers found that altered environment and atomospheric factors could be associated with organ-specific lupus outbreaks in patients diagnosed with systemic lupus erythematosus (SLE). The results of the study were presented at the ACR / ARP Annual Meeting 2019. The summary was titled “Environmental and Atmospheric Factors in Systemic Lupus Erythematosus: A Regression Analysis”.

The researchers explained that SLE is a chronic disease that results in inflammation that can affect various organs in the body, including the skin and joints. The kidneys, lungs, and even the brain and heart can be affected by SLE. Non-specific symptoms including fever, fatigue or lethargy, weight loss, etc. are common features of these conditions. This study reveals that environmental factors may play a role in the ups and downs associated with this disease. Knowing these factors could also help doctors and rheumatologists warn their patients accordingly and take necessary management actions, the researchers said.

Exposure to the sun can cause flare-ups of lupus. The most serious manifestation of lupus is kidney and / or brain damage. Lupus occurs ten times more often in women than in men. Image Credit: Korn Ratchaneekorn / Shutterstock

For this study, the team examined the effects of fine particulate matter (PM2.5) concentration, temperature, relative humidity, resulting winds, ozone concentration, and barometric pressure on relapses associated with different organs in patients with SLE.

Lead author George Stojan, MD, assistant professor of medicine, Johns Hopkins Lupus Center, said in a statement that in a recent study they found that there are 40 known nucleotide polymorphisms or SNPs that are important in lupus . However, these do occur in a very small proportion of people and therefore environmental factors could be directly linked to lupus flare-ups. Stojan said, “There is strong epidemiological evidence for association with several environmental factors, including exposure to crystalline silica, smoking, and exogenous estrogen, as well as potential associations between other exogenous factors such as mercury. , ultraviolet rays, solvents and pesticides.

Stojan added, “Regarding atmospheric impact, data from the Hopkins Lupus Center previously described significant seasonal variation in SLE disease activity with more arthritic activity in the spring and summer, and an increase in arthritis activity. increased kidney activity during the winter months. – antibody titers against dsDNA in the fall and a significant variation in global disease activity throughout the year. While several studies in the past have attempted to correlate the overall activity of SLE disease with changes in the atmosphere, this is the first study to examine the association of organ-specific lupus outbreaks with changes in the air before. patient visits.

For this study, the research team included 1,628 patients. These patients had at least four of the eleven ACR or SLICC classification criteria for SLE and were therefore confirmed by the diagnosis of SLE. These patients were followed between 1999 and 2017. At each visit to the doctor, the level of disease was measured using the Physician Global Assessment (PGA). If the PGA score increased by one point from the previous visit, it was considered a lupus flare, the researchers wrote. Data from the U.S. Environmental Protection Agency (EPA) was used for the environmental data, the researchers wrote. They calculated the average values ​​of the environmental parameters for each of the patients ten days before their doctor’s visit. Other factors such as patient age, gender, socioeconomic status, racial and ethnic groups, and urban or rural residence were taken into account before the association between environmental change and SLE became evident. can be calculated. These factors acted as confounding factors, the researchers wrote.

The results revealed that there was a significant association between environmental changes and lupus flare-ups. For example, with the increase in temperature, there appeared to be a flare-up of lupus rash, seritis, joint flares, and blood disorders. As temperatures and ozone levels rose, there was a decrease in flare-ups of kidney disease. Residual wind changes were associated with pulmonary, renal, cerebral, blood and joint surges. As the concentration of PM2.5 increased, there were more complaints of rashes, joint problems, seritis, and blood disorders in patients with SLE. Moisture was also associated with serositis, joint problems, etc. None of the environmental factors affected all of the various symptoms of SLE, however, the researchers wrote.

Dr Stojan said: ‘These findings raise concerns about a potentially significant impact of atmospheric changes on the occurrence of organ-specific lupus flare-ups, but more studies are needed to confirm and potentially explain this effect. . Atmospheric effects can have a significant impact on the design and results of clinical trials in lupus. He concluded: “From a global perspective, these findings could implicate climate change and global warming as important factors in the rapidly changing epidemiology of lupus around the world. Ultimately, these results are the first step in justifying the vast majority of lupus patients who are convinced that their disease is influenced by climate change and who have inspired this research. “

The authors of the study concluded: “These data could add an important aspect to the lupus trials, the results of which could be affected by previously unrecognized environmental factors, and could ultimately allow predictive modeling of lupus. lupus flare-ups, which would revolutionize the approach to treatment. “

Journal reference:

Stojan G, Curriero F, Kvit A, Petri M. Environmental and atmospheric factors in systemic lupus erythematosus: regression analysis [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). Accessed November 11, 2019.

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