Exposure to fine particles may trigger pulmonary inflammation/systemic inflammation. The objective of this study was to investigate the association between daily individual exposure to air pollutants and airway inflammation and disease activity in childhood-onset systemic lupus erythematosus (cSLE) patients. A longitudinal panel study was carried out in 108 consecutive appointments with cSLE patients without respiratory diseases. Over four consecutive weeks, daily individual measures of nitrogen dioxide (NO), fine particulate matter (PM), ambient temperature, and humidity were obtained. This cycle was repeated every 2.5 months along 1 year, and cytokines of exhaled breath condensate-EBC [interleukins (IL) 6, 8, 17 and tumoral necrose factor-α (TNF-α)], fractional exhaled NO (FeNO), and disease activity parameters were collected weekly. Specific generalized estimation equation models were used to assess the impact of these pollutants on the risk of Systemic Lupus Erythematous Disease Activity Index 2000 (SLEDAI-2K) ≥ 8, EBC cytokines, and FeNO, considering the fixed effects for repetitive measurements. The models were adjusted for inflammatory indicators, body mass index, infections, medication, and weather variables. An IQR increase in PM 4-day moving average (18.12 μg/m) was associated with an increase of 0.05 pg/ml (95% CI 0.01; 0.09, p = 0.03) and 0.04 pg/ml (95% CI 0.02; 0.06, p = 0.01) in IL-17 and TNF-α EBC levels, respectively. Additionally, a short-term effect on FeNO was observed: the PM 3-day moving average was associated with a 0.75 ppb increase (95% CI 0.38; 1.29, p = 0.03) in FeNO. Also, an increase of 1.47 (95% CI 1.10; 1.84) in the risk of SLEDAI-2K ≥ 8 was associated with PM 7-day moving average. Exposure to inhalable fine particles increases airway inflammation/pulmonary and then systemic inflammation in cSLE patients.
This is the largest study on juvenile-onset Takayasu arteritis, and a high number of patients under the age of 10 years, with predominance of constitutional symptoms early in the disease, was observed.
This is the largest study on juvenile-onset Takayasu arteritis, and a high number of patients under the age of 10 years, with predominance of constitutional symptoms early in the disease, was observed.
BackgroundRecently, we showed that exposure to outdoors pollutants was associated with an increase of hospitalizations in paediatric rheumatic diseases (1) and higher risk of disease activity in our childhood-onset systemic lupus erythematous (cSLE) patients (2).Exhaled breath biomarkers measurements, such as exhaled breath condensate (EBC) and fractional concentration of exhaled nitric oxide (FeNO) may indicate airways inflammation related to air pollutant exposure. To our knowledge, this was the first study that showed the effects of daily exposure to PM2.5, assessed by personal real time monitoring, on airway inflammation and increased risk of disease activity in cSLE patients.ObjectivesTo investigate the association between daily individual real-time exposure to air pollutants and disease activity in cSLE patients.MethodsA longitudinal panel study was carried-out in 108 consecutive visits of cSLE patients. During four consecutive weeks, daily personal measures of nitrogen dioxide (NO2), fine particulate matter (PM2,5), ambient temperature and humidity were obtained.This cycle was repeated every 2.5 months along one year and pH of exhaled breath condensate (EBC pH), fractional exhaled NO (FeNO) and disease activity parameters were collected weekly. Specific generalized estimation equation models were used to assess the impact of these pollutants on the risk of moderate/severe disease activity (SLEDAI-2K≥8), EBC pH and FeNO considering the fixed effects for repetitive measurements. The models were adjusted for inflammatory indicator, body mass index, infection, medication and weather variables.ResultsFor an interquartile range increase of 18.12μg/m3 in PM2.5 daily concentration we observed an increased short-term effect in FeNO at the first three days (lag 0 to lag 2) after exposure. The 3-day moving average effect on FeNO was an increase of 0.75 ppb (95%IC: 0.38–1.29). Decreases in EBC pH were evidenced at days 7 and 10 after exposure [0.09 (95%IC: 0.15–0.02); 0.09 (95%IC: 0.17–0.01) respectively]. Regarding the risk of SLEDAI-2K ≥8, an increase of 18.12 μg/m3 in PM2.5 was associated with increases in the risk of SLEDAI-2K ≥8 at four [RR 1.45 (95%CI: 1.24–1.66)] and 11 days [RR 1.34 (95%CI: 1.05–1.62)] after exposure.ConclusionsReal-time exposure to air pollution may have a role in triggering disease activity and airways inflammation in cSLE patients.ReferencesVidotto JP, Pereira LAA, Braga ALF et al. Atmospheric pollution:influence on hospital admission in pediatric rheumatic disease. Lupus. 2012;21:526–33Fernandes EC, Silva CA, Braga ALF, Sallum AM, Campos LM, Farhat SC. Exposure to air pollutants increased disease activity in childhood-onset systemic lupus erythematosus patients. Arthritis Care Res. 2015; 67:1609–14.AcknowledgementSupported by Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP 13/21508–2), Conselho Nacional de Desenvolvimento Científico e Tecnolόgico (CNPQ 302724/2011–7 and 472155/2012–1), Federico Foundation and Núcleo de Apoio à Pesquisa “Saúde da Criança e do Adolescente” da USP...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.