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van der Woude D, Toes REM. Immune response to post-translationally modified proteins in rheumatoid arthritis: what makes it special? Ann Rheum Dis 2024; 83:838-846. [PMID: 38378236 DOI: 10.1136/ard-2023-224103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/01/2024] [Indexed: 02/22/2024]
Abstract
Rheumatoid arthritis (RA) exhibits common characteristics with numerous other autoimmune diseases, including the presence of susceptibility genes and the presence of disease-specific autoantibodies. Anti-citrullinated protein antibodies (ACPA) are the hallmarking autoantibodies in RA and the anti-citrullinated protein immune response has been implicated in disease pathogenesis. Insight into the immunological pathways leading to anti-citrullinated protein immunity will not only aid understanding of RA pathogenesis, but may also contribute to elucidation of similar mechanisms in other autoantibody-positive autoimmune diseases. Similarly, lessons learnt in other human autoimmune diseases might be relevant to understand potential drivers of RA. In this review, we will summarise several novel insights into the biology of the anti-citrullinated protein response and their clinical associations that have been obtained in recent years. These insights include the identification of glycans in the variable domain of ACPA, the realisation that ACPA are polyreactive towards other post-translational modifications on proteins, as well as new awareness of the contributing role of mucosal sites to the development of the ACPA response. These findings will be mirrored to emerging concepts obtained in other human (autoimmune) disease characterised by disease-specific autoantibodies. Together with an updated understanding of genetic and environmental risk factors and fresh perspectives on how the microbiome could contribute to antibody formation, these advancements coalesce to a progressively clearer picture of the B cell reaction to modified antigens in the progression of RA.
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Affiliation(s)
| | - René E M Toes
- Rheumatology, Leids Universitair Medisch Centrum, Leiden, The Netherlands
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2
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Dellaripa PF, Sung LH, Bain PA, Lanata C, Blazar A, Miller FW, Feldman CH. American College of Rheumatology White Paper: The Effects of Climate Change on Rheumatic Conditions-An Evolving Landscape and a Path Forward. Arthritis Rheumatol 2024. [PMID: 38751102 DOI: 10.1002/art.42919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 05/03/2024] [Accepted: 05/13/2024] [Indexed: 06/06/2024]
Abstract
OBJECTIVE Increases in global temperatures and extreme weather events associated with climate change have complex yet poorly understood detrimental impacts on human health. We reviewed the current published literature on climate change-related effects and rheumatic conditions. METHODS To summarize our current understanding of the likely effects of climate change, including increased air pollution, on rheumatic disease, we searched the published, peer-reviewed English-language literature from January 2000 to December 2022. Articles were reviewed by a team of rheumatologists and clinical and translational science researchers. Systematic review articles were not included but informed additional literature searches. RESULTS After extensive examination and adjudication, 88 articles met inclusion criteria and were selected for review. Much of the epidemiologic investigations assessed associations between air pollution and increased risk of development of rheumatoid arthritis, anti-citrullinated protein antibodies, flares of gout, and hospitalizations for systemic lupus erythematosus. Increased heat vulnerability was associated with higher odds of recurrent hospitalizations across rheumatic conditions. Mechanisms for observed associations are poorly understood but could include the effects of epigenetic changes, oxidative stress, and inflammatory cytokines. Studies had limitations, including restricted geography and populations studied without focus on historically marginalized communities at highest risk for adverse effects from pollution and climate change, the relative lack of mechanistic evaluations, and most with only indirect links to climate change. CONCLUSION To date, the published literature lacks studies that directly examine effects of climate change on rheumatic diseases. Collaborative translational and epidemiologic research is needed to enhance our understanding and awareness in this area.
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Affiliation(s)
- Paul F Dellaripa
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Paul A Bain
- Harvard Medical School, Boston, Massachusetts
| | - Cristina Lanata
- National Human Genome Research Institution, NIH, Bethesda, Maryland
| | | | - Frederick W Miller
- National Institute of Environmental Health Sciences, NIH, Durham, North Carolina
| | - Candace H Feldman
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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3
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Moore JM, Norris JM, Clark ML. Exposure to air pollutants and rheumatoid arthritis biomarkers: A scoping review. Semin Arthritis Rheum 2024; 65:152365. [PMID: 38232624 DOI: 10.1016/j.semarthrit.2024.152365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/20/2023] [Accepted: 01/03/2024] [Indexed: 01/19/2024]
Abstract
INTRODUCTION Rheumatoid arthritis (RA) is a common autoimmune disease with a complex and poorly understood etiology that includes genetic, hormonal, and environmental factors. OBJECTIVE Our objective was to assess current literature that investigated the association between exposure to environmental and occupational air pollutants and RA-related biomarkers rheumatoid factor (RF) and anti-citrullinated peptide antibody (ACPA). DESIGN PubMed and Web of Science were used to identify epidemiological studies that measured or estimated air pollution and at least one RA biomarker. Information was charted for comparison of evidence, including pollutant(s) studied, exposure assessment, biomarker measurement, analysis method, study population, size, dates, adjustment variables, and findings. RESULTS Several common air pollutants (including two mixtures) and a few dozen occupational inhalants were assessed in 13 eligible studies. Associations between industrial sulfur dioxide and particulate matter less than 2.5 µm in diameter with ACPA were observed most frequently, including associations between residential proximity to pollution sources and ACPA positivity. Consistency of associations with other pollutants was either not observed or limited to single studies. Three studies evaluated the modifying impact of SE alleles (a genetic factor associated with RA) and found that pollutant associations were stronger among participants positive for SE alleles. CONCLUSION Based on mixed results, there was no consistent link between any single pollutant and RA-related biomarker outcomes. Comparisons across studies were limited by differences in study populations (e.g., by RA status, by sociodemographic groups) and study design (including designs focused on different sources of air pollution, methodological approaches with varying levels of potential exposure misclassification, and assessments of inconsistent biomarker cut-points). However, given that multiple studies reported associations between exposure to air pollution and RA biomarkers, continued exploration utilizing studies that can be designed with a more robust causal framework, including continued consideration of effect modification by genetic status, may be necessary.
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Affiliation(s)
- Jillian M Moore
- Department of Environmental and Radiological Health Sciences, Colorado State University, 1681 Campus Delivery, Fort Collins, CO 80523, USA
| | - Jill M Norris
- Department of Epidemiology, Colorado School of Public Health, Aurora CO, USA
| | - Maggie L Clark
- Department of Environmental and Radiological Health Sciences, Colorado State University, 1681 Campus Delivery, Fort Collins, CO 80523, USA.
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Merjanah S, Liew JW, Bihn J, Fillmore NR, Brophy MT, Do NV, Dubreuil M. Trends in Fracture Rates Over Two Decades Among Veterans With Ankylosing Spondylitis. Arthritis Care Res (Hoboken) 2023; 75:2481-2488. [PMID: 37308459 PMCID: PMC10704387 DOI: 10.1002/acr.25166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 04/09/2023] [Accepted: 05/23/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVE There is an increased risk of fracture in individuals with ankylosing spondylitis (AS) compared to the general population, possibly due to systemic inflammatory effects. The use of tumor necrosis factor inhibitors (TNFi) may reduce fracture risk by inhibiting inflammation. We assessed fracture rates in AS versus non-AS comparators and whether these rates have changed since the introduction of TNFi. METHODS We used the national Veterans Affairs database to identify adults ≥18 years old with ≥1 International Classification of Diseases, Ninth Revision (ICD-9)/ICD-10 code for AS and at least 1 disease-modifying antirheumatic drug prescription. As comparators, we selected a random sample of adults without AS diagnosis codes. We calculated fracture incidence rates for AS and comparators, with direct standardization to the cohort structure in 2017. To compare fracture rates from 2000 to 2002 (pre-TNFi) versus 2004-2020 (TNFi era), we performed an interrupted time series analysis. RESULTS We included 3,794 individuals with AS (mean age 53 years, 92% male) and 1,152,805 comparators (mean age 60 years, 89% male). For AS, the incidence rate of fractures increased from 7.9/1,000 person-years in 2000 to 21.6/1,000 person-years in 2020. The rate also increased among comparators, although the ratio of fracture rates (AS/comparators) remained relatively stable. In the interrupted time series, the fracture rate for AS patients in the TNFi era was nonsignificantly increased compared to the pre-TNFi era. CONCLUSION Fracture rates have increased over time for both AS and non-AS comparators. The fracture rate in individuals with AS did not decrease after TNFi introduction in 2003.
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Affiliation(s)
- Sali Merjanah
- Section of Rheumatology, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
| | - Jean W. Liew
- Section of Rheumatology, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
| | - John Bihn
- VA Cooperative Studies Program, VA Boston Healthcare System, Boston, MA
| | - Nathanael R. Fillmore
- VA Cooperative Studies Program, VA Boston Healthcare System, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Mary T. Brophy
- VA Cooperative Studies Program, VA Boston Healthcare System, Boston, MA
- Section of Hematology and Medical Oncology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
| | - Nhan V. Do
- VA Cooperative Studies Program, VA Boston Healthcare System, Boston, MA
- Section of General Internal Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
| | - Maureen Dubreuil
- Section of Rheumatology, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA
- VA Boston Department of Medicine, VA Boston Healthcare System, Boston, MA
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5
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Kronzer VL, Sparks JA. Occupational inhalants, genetics and the respiratory mucosal paradigm for ACPA-positive rheumatoid arthritis. Ann Rheum Dis 2023; 82:303-305. [PMID: 36600176 DOI: 10.1136/ard-2022-223286] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022]
Affiliation(s)
| | - Jeffrey A Sparks
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA .,Department of Medicine, Harvard Medical School, Boston, MA, USA
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Adami G. Mining the pathogenesis of rheumatoid arthritis, the leading role of the environment. RMD Open 2022; 8:rmdopen-2022-002807. [PMID: 36597981 PMCID: PMC9748982 DOI: 10.1136/rmdopen-2022-002807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 11/27/2022] [Indexed: 12/15/2022] Open
Abstract
The environment plays a crucial role in the pathogenesis of various diseases, including rheumatic musculoskeletal diseases (RMDs). Chronic exposure to air pollution has been associated with a number of detrimental effects on the immune system, including direct activation of autoimmunity and autoantibodies production. Rheumatoid arthritis (RA) is a paradigmatic example of the link between environmental stimuli and development of autoimmunity. Recent evidence has confirmed such association and provided further indication of the strict relationship between the lungs and the synovial tissue. Hard rock mining and chronic exposure to airborne fine particulate matter have been associated with higher risk of developing RA. In addition, new evidence showed a peculiar association between acute exposure to toxic inhalants and risk of RA flare. In conclusion, the environment is the straw that breaks the camel's back, unfortunately the "straws" are rapidly accumulating, and their burden is projected to increase accordingly.
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Affiliation(s)
- Giovanni Adami
- Medicine, Rheumatology Unit, Universita degli Studi di Verona Scuola di Medicina e Chirurgia, Verona, Italy
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7
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Epidemiologic Opportunities and Challenges in Studying Environmental Risk Factors for Rheumatic Diseases. Rheum Dis Clin North Am 2022; 48:763-779. [PMID: 36332994 DOI: 10.1016/j.rdc.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Most rheumatic diseases have a stronger environmental than hereditary etiology. This article summarizes the key environmental risk factors for rheumatic diseases, the data sources that generated these findings, and the key pitfalls with existing research that every rheumatology clinician should know. Emerging research opportunities hold promise to revolutionize this field, and soon.
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Luedders BA, Mikuls TR, Thiele GM, Poole JA, England BR. Inhalant and Additional Mucosal-Related Environmental Risks for Rheumatoid Arthritis. Rheum Dis Clin North Am 2022; 48:781-798. [PMID: 36332995 PMCID: PMC10120871 DOI: 10.1016/j.rdc.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Rheumatoid arthritis (RA) occurs as the result of a complex interplay of environmental factors in a genetically susceptible individual. There is considerable evidence that the lungs may serve as an initial site of tolerance loss in the generation of RA-related autoimmunity, and several environmental inhalant exposures and lung diseases have been associated with RA risk. There is additional evidence that immune and microbial dysregulation of other mucosal sites, including the oral and gastrointestinal mucosa, may contribute to the development of RA. Epidemiologic evidence linking mucosal exposures to various environmental insults as risk determinants in RA will be reviewed.
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Affiliation(s)
- Brent A Luedders
- Division of Rheumatology & Immunology, University of Nebraska Medical Center, 986270 Nebraska Medical Center, Omaha, NE 68198-6270, USA; VA Nebraska-Western Iowa Health Care System, 4101 Woolworth Avenue, Omaha, NE 68105, USA
| | - Ted R Mikuls
- Division of Rheumatology & Immunology, University of Nebraska Medical Center, 986270 Nebraska Medical Center, Omaha, NE 68198-6270, USA; VA Nebraska-Western Iowa Health Care System, 4101 Woolworth Avenue, Omaha, NE 68105, USA
| | - Geoffrey M Thiele
- Division of Rheumatology & Immunology, University of Nebraska Medical Center, 986270 Nebraska Medical Center, Omaha, NE 68198-6270, USA; VA Nebraska-Western Iowa Health Care System, 4101 Woolworth Avenue, Omaha, NE 68105, USA
| | - Jill A Poole
- Division of Allergy & Immunology, University of Nebraska Medical Center, 985990 Nebraska Medical Center, Omaha, NE 68198-5990, USA
| | - Bryant R England
- Division of Rheumatology & Immunology, University of Nebraska Medical Center, 986270 Nebraska Medical Center, Omaha, NE 68198-6270, USA; VA Nebraska-Western Iowa Health Care System, 4101 Woolworth Avenue, Omaha, NE 68105, USA.
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9
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Natalini JG, England BR, Baker JF, Chen Q, Singh N, Mahajan TD, Roul P, Thiele GM, Sauer BC, Mikuls TR, Johnson FB, Kawut SM. Associations between shortened telomeres and rheumatoid arthritis-associated interstitial lung disease among U.S. Veterans. Respir Med 2022; 201:106943. [PMID: 35947933 PMCID: PMC10120870 DOI: 10.1016/j.rmed.2022.106943] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Shortened telomeres are associated with several different subtypes of interstitial lung disease (ILD), although studies of telomere length and ILD in rheumatoid arthritis (RA) are lacking. METHODS Within the Veterans Affairs Rheumatoid Arthritis (VARA) registry, we performed cross-sectional and case-control studies of prevalent and incident ILD, respectively. We randomly selected a subset of RA patients with ILD and individually matched them to RA patients without ILD according to age, sex, and VARA enrollment date. Telomere length was measured on peripheral blood leukocytes collected at registry enrollment using quantitative PCR (T/S ratio). Short telomeres were defined as a T/S ratio in the lowest 10th percentile of the cohort. RESULTS Our cross-sectional study cohort was comprised of 54 RA-ILD patients and 92 RA-non-ILD patients. T/S ratios significantly differed between patients with and without prevalent ILD (1.56 [IQR 1.30, 1.78] vs. 1.96 [IQR 1.65, 2.27], p < 0.001). Similarly, prevalence of ILD was significantly higher in patients with short vs. normal-length telomeres (73.3% vs. 32.8%, p = 0.002). Short telomeres were independently associated with an increased odds of prevalent ILD compared to normal-length telomeres (adjusted OR 6.60, 95% CI 1.78-24.51, p = 0.005). In our case-control analysis, comprised of 22 incident RA-ILD cases and 36 RA-non-ILD controls, short telomeres were not associated with incident RA-ILD (adjusted OR 0.90, 95% CI 0.06-13.4, p = 0.94). CONCLUSION Short telomeres were strongly associated with prevalent but not incident ILD among patients with RA. Additional studies are needed to better understand telomere length dynamics among RA patients with and without ILD.
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Affiliation(s)
- Jake G Natalini
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States.
| | - Bryant R England
- Division of Rheumatology and Immunology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, United States; VA Nebraska-Western Iowa Health Care System, Omaha, NE, United States
| | - Joshua F Baker
- Division of Rheumatology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States; Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States
| | - Qijun Chen
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Namrata Singh
- Division of Rheumatology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Tina D Mahajan
- Division of Rheumatology and Immunology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, United States
| | - Punyasha Roul
- Division of Rheumatology and Immunology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, United States
| | - Geoffrey M Thiele
- Division of Rheumatology and Immunology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, United States
| | - Brian C Sauer
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Ted R Mikuls
- Division of Rheumatology and Immunology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, United States; VA Nebraska-Western Iowa Health Care System, Omaha, NE, United States
| | - F Bradley Johnson
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Steven M Kawut
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
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10
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Poole JA, Mikuls TR, Thiele GM, Gaurav R, Nelson AJ, Duryee MJ, Mitra A, Hunter C, Wyatt TA, England BR, Ascherman DP. Increased susceptibility to organic dust exposure-induced inflammatory lung disease with enhanced rheumatoid arthritis-associated autoantigen expression in HLA-DR4 transgenic mice. Respir Res 2022; 23:160. [PMID: 35717175 PMCID: PMC9206339 DOI: 10.1186/s12931-022-02085-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 06/13/2022] [Indexed: 11/10/2022] Open
Abstract
Immunogenetic as well as environmental and occupational exposures have been linked to the development of rheumatoid arthritis (RA), RA-associated lung disease, and other primary lung disorders. Importantly, various inhalants can trigger post-translational protein modifications, resulting in lung autoantigen expression capable of stimulating pro-inflammatory and/or pro-fibrotic immune responses. To further elucidate gene-environment interactions contributing to pathologic lung inflammation, we exploited an established model of organic dust extract (ODE) exposure with and without collagen-induced arthritis (CIA) in C57BL/6 wild type (WT) versus HLA-DR4 transgenic mice. ODE-induced airway infiltration driven by neutrophils was significantly increased in DR4 versus WT mice, with corresponding increases in bronchoalveolar lavage fluid (BALF) levels of TNF-⍺, IL-6, and IL-33. Lung histopathology demonstrated increased number of ectopic lymphoid aggregates comprised of T and B cells following ODE exposure in DR4 mice. ODE also induced citrullination, malondialdehyde acetaldehyde (MAA) modification, and vimentin expression that co-localized with MAA and was enhanced in DR4 mice. Serum and BALF anti-MAA antibodies were strikingly increased in ODE-treated DR4 mice. Coupling ODE exposure with Type II collagen immunization (CIA) resulted in similarly augmented pro-inflammatory lung profiles in DR4 mice (relative to WT mice) that was accompanied by a profound increase in infiltrating lung CD4+ and CD8+ T cells as well as CD19+CD11b+ autoimmune B cells. Neither modeling strategy induced significant arthritis. These findings support a model in which environmental insults trigger enhanced post-translational protein modification and lung inflammation sharing immunopathological features with RA-associated lung disease in the selected immunogenetic background of HLA-DR4 mice.
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Affiliation(s)
- Jill A. Poole
- grid.266813.80000 0001 0666 4105Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE USA
| | - Ted R. Mikuls
- grid.266813.80000 0001 0666 4105Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE USA ,grid.413785.cVeterans Affairs Nebraska-Western Iowa Health Care System, Research Service, Omaha, NE USA
| | - Geoffrey M. Thiele
- grid.266813.80000 0001 0666 4105Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE USA ,grid.413785.cVeterans Affairs Nebraska-Western Iowa Health Care System, Research Service, Omaha, NE USA
| | - Rohit Gaurav
- grid.266813.80000 0001 0666 4105Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE USA
| | - Amy J. Nelson
- grid.413785.cVeterans Affairs Nebraska-Western Iowa Health Care System, Research Service, Omaha, NE USA
| | - Michael J. Duryee
- grid.266813.80000 0001 0666 4105Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE USA ,grid.413785.cVeterans Affairs Nebraska-Western Iowa Health Care System, Research Service, Omaha, NE USA
| | - Ananya Mitra
- grid.266813.80000 0001 0666 4105Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE USA
| | - Carlos Hunter
- grid.266813.80000 0001 0666 4105Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE USA
| | - Todd A. Wyatt
- grid.266813.80000 0001 0666 4105Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE USA ,grid.413785.cVeterans Affairs Nebraska-Western Iowa Health Care System, Research Service, Omaha, NE USA ,grid.266813.80000 0001 0666 4105Department of Environmental, Agricultural & Occupational Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE USA
| | - Bryant R. England
- grid.266813.80000 0001 0666 4105Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE USA ,grid.413785.cVeterans Affairs Nebraska-Western Iowa Health Care System, Research Service, Omaha, NE USA
| | - Dana P. Ascherman
- grid.21925.3d0000 0004 1936 9000Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA USA
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Rheumatoid Arthritis in Silica-Exposed Workers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312776. [PMID: 34886499 PMCID: PMC8657481 DOI: 10.3390/ijerph182312776] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 11/29/2021] [Accepted: 12/02/2021] [Indexed: 11/21/2022]
Abstract
Few studies have examined rheumatoid arthritis (RA) risk and severity in Korean workers exposed to silica. We compared the hospitalization risk of RA between silica-exposed workers and the general Korean population. The study cohort consisted of male workers exposed to silica who had undergone at least one silica-associated special medical examination between 1 January 2000 and 31 December 2004 (N = 149,948). The data were from the Korea Occupation Safety and Health Agency. RA morbidity based on hospital admission records was estimated from 2000 to 2005 using the Korea National Health Insurance Service claims data. The standardized admission ratio (SAR) was calculated by dividing the observed number of admissions in silica-exposed workers by the expected number of admissions in the general reference population. For the sum of “Seropositive rheumatoid arthritis” (M05) and “Other rheumatoid arthritis” (M06), the SAR was higher in the silica-exposed group (1.34, 95% CI 1.08–1.64). For M05, workers with <10 years of silica exposure had a significantly higher SAR (2.54, 95% CI 1.10–5.01) than the general population. More silica-exposed workers without a diagnosis of pneumoconiosis were hospitalized for RA than the general population. Our analysis reaffirms the link between silica exposure and RA and suggests that the severity of RA is increased by silica. Further studies of silica-exposed workers with longer follow-up are needed.
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12
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Mikuls TR, Gaurav R, Thiele GM, England BR, Wolfe MG, Shaw BP, Bailey KL, Wyatt TA, Nelson AJ, Duryee MJ, Hunter CD, Wang D, Romberger DJ, Ascherman DP, Poole JA. The impact of airborne endotoxin exposure on rheumatoid arthritis-related joint damage, autoantigen expression, autoimmunity, and lung disease. Int Immunopharmacol 2021; 100:108069. [PMID: 34461491 PMCID: PMC8551041 DOI: 10.1016/j.intimp.2021.108069] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/15/2021] [Accepted: 07/15/2021] [Indexed: 12/11/2022]
Abstract
Airborne biohazards are risk factors in the development and severity of rheumatoid arthritis (RA) and RA-associated lung disease, yet the mechanisms explaining this relationship remain unclear. Lipopolysaccharide (LPS, endotoxin) is a ubiquitous inflammatory agent in numerous environmental and occupational air pollutant settings recognized to induce airway inflammation. Combining repetitive LPS inhalation exposures with the collagen induced arthritis (CIA) model, DBA1/J mice were assigned to either: sham (saline injection/saline inhalation), CIA (CIA/saline), LPS (saline/LPS 100 ng inhalation), or CIA + LPS for 5 weeks. Serum anti-citrullinated (CIT) protein antibody (ACPA) and anti-malondialdehyde-acetaldehyde (MAA) antibodies were strikingly potentiated with co-exposure (CIA + LPS). CIT- and MAA-modified lung proteins were increased with co-exposure and co-localized across treatment groups. Inhaled LPS exacerbated arthritis with CIA + LPS > LPS > CIA versus sham. Periarticular bone loss was demonstrated in CIA and CIA + LPS but not in LPS alone. LPS induced airway inflammation and neutrophil infiltrates were reduced with co-exposure (CIA + LPS). Potentially signaling transition to pro-fibrotic processes, there were increased infiltrates of activated CD11c+CD11b+ macrophages and transitioning CD11c+CD11bint monocyte-macrophage populations with CIA + LPS. Moreover, several lung remodeling proteins including fibronectin and matrix metalloproteinases as well as complement C5a were potentiated with CIA + LPS compared to other treatment groups. IL-33 concentrations in lung homogenates were enhanced with CIA + LPS with IL-33 lung staining driven by LPS. IL-33 expression was also significantly increased in lung tissues from patients with RA-associated lung disease (N = 8) versus controls (N = 7). These findings suggest that patients with RA may be more susceptible to developing interstitial lung disease following airborne biohazard exposures enriched in LPS.
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MESH Headings
- Air Pollutants/adverse effects
- Animals
- Arthritis, Experimental/complications
- Arthritis, Experimental/diagnosis
- Arthritis, Experimental/immunology
- Arthritis, Experimental/pathology
- Arthritis, Rheumatoid/complications
- Arthritis, Rheumatoid/diagnosis
- Arthritis, Rheumatoid/immunology
- Arthritis, Rheumatoid/pathology
- Autoantibodies/immunology
- Autoantigens/immunology
- Case-Control Studies
- Dust
- Healthy Volunteers
- Humans
- Inhalation Exposure/adverse effects
- Interleukin-33/analysis
- Interleukin-33/metabolism
- Lipopolysaccharides/adverse effects
- Lung/immunology
- Lung/pathology
- Lung Diseases, Interstitial/immunology
- Lung Diseases, Interstitial/pathology
- Male
- Mice
- Severity of Illness Index
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Affiliation(s)
- Ted R Mikuls
- Veterans Affairs Nebraska-Western Iowa Health Care System, Research Service, Omaha, NE, USA; Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Rohit Gaurav
- Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Geoffrey M Thiele
- Veterans Affairs Nebraska-Western Iowa Health Care System, Research Service, Omaha, NE, USA; Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Bryant R England
- Veterans Affairs Nebraska-Western Iowa Health Care System, Research Service, Omaha, NE, USA; Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Madison G Wolfe
- Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Brianna P Shaw
- Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Kristina L Bailey
- Veterans Affairs Nebraska-Western Iowa Health Care System, Research Service, Omaha, NE, USA; Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Todd A Wyatt
- Veterans Affairs Nebraska-Western Iowa Health Care System, Research Service, Omaha, NE, USA; Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA; Department of Environmental, Agricultural & Occupational Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Amy J Nelson
- Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Michael J Duryee
- Veterans Affairs Nebraska-Western Iowa Health Care System, Research Service, Omaha, NE, USA; Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Carlos D Hunter
- Veterans Affairs Nebraska-Western Iowa Health Care System, Research Service, Omaha, NE, USA; Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Dong Wang
- Pharmaceutical Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Debra J Romberger
- Veterans Affairs Nebraska-Western Iowa Health Care System, Research Service, Omaha, NE, USA; Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Dana P Ascherman
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jill A Poole
- Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA.
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13
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Frech TM, Murtaugh MA, Amuan M, Pugh MJ. The frequency of Raynaud's phenomenon, very early diagnosis of systemic sclerosis, and systemic sclerosis in a large Veteran Health Administration database. BMC Rheumatol 2021; 5:42. [PMID: 34649624 PMCID: PMC8518247 DOI: 10.1186/s41927-021-00209-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 06/28/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND We describe Raynauds phenomenon (RP), potential very early diagnosis of systemic sclerosis (VEDOSS), and systemic sclerosis (SSc) in Veterans deployed in support of Post-9/11 operations. We sought to describe the military occupation specialty, clinical features, and vasodilator use across the three diagnoses. METHODS Individual Veterans medical records were assessed for RP (ICD-9443.0), VEDOSS with swelling of hands (ICD-9729.81) and RP (ICD-9443.0), and SSc (ICD-9710.1). The distribution of sociodemographic, military service branch, job classification, vasodilator use, and comorbidities were examined across the three classifications of disease. The chi-squared test and Fisher's exact compared frequency of these categorical variables. Logistic regression assessed the likelihood of characteristics of the three classifications. RESULTS In this population of 607,665 individual Veteran medical records, 857 had RP, 45 met possible VEDOSS criteria, and 71 had a diagnosis of SSc. The majority of RP, potential VEDOSS and SSc cases were white males. Those in craftworks, engineering or maintenance, and healthcare had a greater likelihood of RP. Less than half of RP and VEDOSS patients were on vasodilators. The most common comorbidities in this population were the diagnostic code for pain (highest in the potential VEDOSS group [81.6%]), followed by depression in all groups. CONCLUSION This is a unique Veteran population of predominately-male patients. Our data suggests that vasodilator medications are potentially being under-utilized for RP and potential VEDOSS. Our data highlights mood and pain management as an important aspect of SSc care.
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Affiliation(s)
- Tracy M Frech
- Department of Internal Medicine, Division of Rheumatology, University of Utah and Salt Lake Veterans Affair Medical Center, 1900 E 30 N, SOM 4b200, Salt Lake City, UT, 84132, USA.
| | - Maureen A Murtaugh
- Department of Internal Medicine, University of Utah and Salt Lake Veterans Affair Medical Center, Division of Epidemiology, Salt Lake City, UT, USA
| | - Megan Amuan
- Department of Internal Medicine, University of Utah and Salt Lake Veterans Affair Medical Center, Division of Epidemiology, Salt Lake City, UT, USA
| | - Mary Jo Pugh
- Department of Internal Medicine, University of Utah and Salt Lake Veterans Affair Medical Center, Division of Epidemiology, Salt Lake City, UT, USA
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14
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Ying D, Schmajuk G, Trupin L, Blanc PD. Inorganic Dust Exposure During Military Service as a Predictor of Rheumatoid Arthritis and Other Autoimmune Conditions. ACR Open Rheumatol 2021; 3:466-474. [PMID: 34085777 PMCID: PMC8281049 DOI: 10.1002/acr2.11273] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE Rheumatoid arthritis (RA) and other autoimmune (AI) conditions are associated with inorganic dust exposure. Many military activities are likely to entail inorganic dust exposures. We wished to identify associations between prior military dust exposure and RA and other AI conditions. METHODS We studied persons from a roster of Army, Navy, Air Force, or Marine Corps personnel who had served in Operation Enduring Freedom and Operations Iraqi Freedom and New Dawn. We linked military occupational codes to a job exposure matrix assigning dust exposure likelihood. We used the Veterans Affairs Health Care System (VAHCS) electronic health care records to identify cases of RA, systemic lupus erythematosus (SLE), systemic sclerosis (SSc), vasculitis, and inflammatory myositis. Generalized estimating equations modeled risk of RA and other AI conditions associated with dust exposure, taking into account military service branch, age at first VAHCS encounter, sex, race/ethnicity, smoking status, and years of military service. RESULTS Of 438 086 veterans (68% ever-smokers), 44% were classified with likely or somewhat likely dust exposure. Cases included 1139 cases with RA, 467 cases with SLE, and 180 cases with other AI diseases (SSc, vasculitis, or inflammatory myositis). Military dust exposure was associated with increased odds of RA (odds ratio [OR] = 1.10; 95% confidence interval [CI] = 1.003-1.20) and increased odds of SSc, vasculitis, or inflammatory myositis (OR = 1.23; 95% CI = 1.14-1.34) but was protective for SLE (OR = 0.81; 95% CI = 0.76-0.88). CONCLUSION Dust exposure during past military service comprises an occupational and environmental risk factor for RA and other AI diseases. This is potentially relevant for prevention activities.
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Affiliation(s)
- David Ying
- San Francisco Veterans Affairs Health Care System, San Francisco, California, John Muir Health, Walnut Creek, California, and University of California at San Francisco
| | - Gabriela Schmajuk
- San Francisco Veterans Affairs Health Care System, San Francisco, California, and University of California at San Francisco
| | | | - Paul D. Blanc
- San Francisco Veterans Affairs Health Care System, San Francisco, California, and University of California at San Francisco
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