Association between environmental air pollution and rheumatoid arthritis flares
Association between environmental air pollution and rheumatoid arthritis flares
复制标题
DOI：
10.1093/rheumatology/keab049
复制
发表时间：
2021-02-14
期刊：
影响因子：
5.5
通讯作者：
Fassio, Angelo
中科院分区：
文献类型：
--
作者：
Adami, Giovanni;Viapiana, Ombretta;Fassio, Angelo
目标。环境空气污染与类风湿性关节炎的发病机制有关。然而，没有证据表明较高浓度的空气污染物与类风湿关节炎复发的风险有关。本研究的目的是确定RA耀斑与空气污染之间的关系。我们收集了维罗纳地区风湿性关节炎患者和空气污染物日浓度的纵向数据。我们设计了一个病例交叉研究。我们比较了关节炎发作前30天和60天的污染物暴露情况，指的是低疾病活动量访问前30天和60天。该研究包括888例RA患者，随访3396次；收集了13 636份每日空气污染记录。我们发现空气污染物浓度与CRP水平异常风险之间存在暴露-反应关系。暴露于空气污染物浓度较高的患者CRP水平>= 5 mg/l的风险较高。CO、NO、NO2、NOx、PM10、PM2.5和O-3的浓度在耀斑发生前60天内较高。我们在一组随访5年的患者中发现，空气污染与类风湿性关节炎疾病严重程度和复发之间存在显著关联。暴露在高水平的空气污染物中与CRP水平升高和关节炎发作的高风险有关。这种过度的风险在极低的暴露水平下是明显的。
Objectives. Environmental air pollution has been linked to the pathogenesis of RA. Nevertheless, evidence linking higher concentrations of air pollutants with the risk of RA reactivations is missing. The objective of the present study was to determine the association between RA flares and air pollution.Methods. We collected longitudinal data of patients affected by RA and of the daily concentration of air pollutants in the Verona area. We designed a case-crossover study. We compared the exposure to pollutants in the 30-day and 60-day periods preceding an arthritic flare referent to the 30-day and 60-day preceding a low-disease activity visit.Results. The study included 888 patients with RA with 3396 follow-up visits; 13 636 daily air pollution records were retrieved. We found an exposure-response relationship between the concentration of air pollutants and the risk of having abnormal CRP levels. Patients exposed to greater concentrations of air pollutants were at higher risk of having CRP levels >= 5 mg/l. Concentrations of CO, NO, NO2, NOx, PM10, PM2.5 and O-3 were higher in the 60-day period preceding a flare.Conclusions. We found a striking association between air pollution and RA disease severity and reactivations in a cohort of patients followed over a 5-year period. The exposure to high levels of air pollutants was associated with increased CRP levels and a higher risk of experiencing a flare of arthritis. This excessive risk was evident at very low levels of exposure.