Lupus flare-ups could be linked to environmental factors

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Researchers have found that altered environmental and atmospheric factors may be associated with organ-specific lupus flare-ups in patients diagnosed with systemic lupus erythematosus (SLE). The results of the study were presented at the 2019 annual meeting of the ACR/ARP. The abstract was titled “Environmental and Atmospheric Factors in Systemic Lupus Erythematosus: A Regression Analysis”.

The researchers explained that SLE is a chronic disease that leads to 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. Nonspecific symptoms, including fever, fatigue or lethargy, weight loss, etc., are common features of the conditions. This study reveals that environmental factors could play a role in the hazards associated with this disease. Knowledge of these factors could also help doctors and rheumatologists warn their patients accordingly and take necessary management actions, the researchers say.

Sun exposure can cause lupus flare-ups. Kidney and/or brain damage is the most serious manifestation of lupus. 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 (PM2.5) concentration, temperature, relative humidity, resultant winds, ozone concentration, and barometric pressure on relapses associated with different organs in patients with SLE.

Senior author George Stojan, MD, assistant professor of medicine, Johns Hopkins Lupus Center, said in a statement that in the recent study, they found that there are 40 known single nucleotide polymorphisms or SNPs that are important in the cause of lupus. These however occur in a very small proportion of individuals and therefore environmental factors could be directly linked to lupus flare-ups. Stojan said: “There is strong epidemiological evidence for associations 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 radiation, solvents and pesticides.”

Stojan added, “With respect to atmospheric impact, data from the Hopkins Lupus Center previously described significant seasonal variation in SLE disease activity with more arthritic activity in spring and summer, and an increase in kidney activity in winter, anti-dsDNA antibody titers in fall, and significant variation in overall disease activity throughout the year. While several studies in the past have attempted to correlate overall SLE disease activity with atmospheric changes, this is the first study to examine the association of organ-specific lupus flare-ups with atmospheric changes 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 with the diagnosis of SLE. These patients were followed between 1999 and 2017. At each of the physician visits, 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 a lupus flare, the researchers write. Data from the US 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 considered before the association between environmental change and SLE could be determined. be calculated. These factors acted as confounders, the researchers wrote.

The results revealed that there was a significant association between environmental changes and lupus flare-ups. For example, as the temperature increased, there seemed to be a flare-up of lupus rashes, serositis, joint flare-ups, and blood disorders. As temperatures and ozone levels increased, there was a decrease in flare-ups of kidney disease. Residual wind shifts have been associated with lung, kidney, brain, blood, and joint flare-ups. As the PM2.5 concentration increased, there were more complaints of skin rashes, joint problems, serositis, and blood disorders in SLE patients. Wetness 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 further studies are needed to confirm this effect and potentially explain it. 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 findings are the first step in vindicating the vast majority of lupus patients who are convinced that their disease is influenced by climate change and which inspired this research.

The study authors wrote in conclusion: “These data could add an important aspect to lupus trials, the results of which may be affected by hitherto unrecognized environmental factors, and ultimately could enable predictive modeling of lupus flare-ups that would revolutionize treatment approach.”

Journal reference:

Stojan G, Curriero F, Kvit A, Petri M. Environmental and atmospheric factors in systemic lupus erythematosus: a regression analysis [abstract]. Rheumatol arthritis. 2019; 71 (supplement 10). https://acrabstracts.org/abstract/environmental-and-atmospheric-factors-in-systemic-lupus-erythematosus-a-regression-analysis/. Accessed November 11, 2019. https://acrabstracts.org/abstract/environmental-and-atmospheric-factors-in-systemic-lupus-erythematosus-a-regression-analysis/

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