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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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Gumtorntip W, Kasitanon N, Louthrenoo W, Chattipakorn N, Chattipakorn SC. Potential roles of air pollutants on the induction and aggravation of rheumatoid arthritis: From cell to bedside studies. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2023; 334:122181. [PMID: 37453681 DOI: 10.1016/j.envpol.2023.122181] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/03/2023] [Accepted: 07/10/2023] [Indexed: 07/18/2023]
Abstract
Rheumatoid arthritis (RA) is an involving chronic systemic inflammatory disease which mainly affects the joints. Several factors including genetic, environment and infections have been acknowledged as being involved in the pathogenesis and aggravation of RA. Air pollution, particularly particulate matter is widely recognized as a cause of health problems. This review is to summarize and discuss the association between air pollutants and the development or the aggravation of RA based on evidence from in vitro, in vivo and clinical studies. The results from the review found that air pollutants can stimulate immunological processes and stimulate inflammatory mediators and autoantibodies productions, both in intro and in vivo studies. In addition, air pollutants can induce RA and aggravate RA disease activity. Unfortunately, there also are some discrepancies in the results, which might be due to the type cell line and the concentration of air pollutants used in the in vitro and in vivo studies, as well as the concentration and duration of exposure in human studies. These findings suggest that future studies focused on elucidating these mechanisms using advanced techniques and identifying reliable biomarkers to assess individual susceptibility and disease activity should be carried out. Longitudinal studies, intervention strategies, and policy implications also should be explored. A comprehensive understanding on these association will facilitate targeted approaches for prevention and management of air pollutant-induced RA and improve health outcome.
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Affiliation(s)
- Wanitcha Gumtorntip
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Nuntana Kasitanon
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Worawit Louthrenoo
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Nipon Chattipakorn
- Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand; Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, 50200, Thailand; Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Siriporn C Chattipakorn
- Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand; Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, 50200, Thailand; Department of Oral Biology and Diagnostic Sciences, Faculty of Dentistry, Chiang Mai University, Chiang Mai, 50200, Thailand.
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Bruera S, Sreedhar A, Agarwal SK, Muthukumar V, Geng Y, Lopez-Olivo MA. Immunosuppression for the treatment of pulmonary hypertension in patients with systemic lupus erythematosus: A systematic review. Int J Rheum Dis 2023. [PMID: 37140198 DOI: 10.1111/1756-185x.14706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/21/2023] [Accepted: 04/08/2023] [Indexed: 05/05/2023]
Abstract
PURPOSE To conduct a systematic review with meta-analysis to determine the effects of immunosuppression on Group 1 Pulmonary Arterial Hypertension in patients with systemic lupus erythematosus (SLE). METHODS We searched Medline, Embase, Web of Science, Clinicaltrials.gov, and Cochrane Central Register of Controlled Trials (CENTRAL) with a search strategy developed by a medical librarian. We included retrospective, cross-sectional, case-control, prospective studies, and randomized controlled trials (RCTs) in our analysis and only included studies that contained data for patients with SLE. We included any immunosuppressive agents (including but not limited to cyclophosphamide, glucocorticoids, mycophenolate mofetil, azathioprine, and rituximab) We assessed for risk of bias and certainty of evidence. Outcomes included hemodynamics (as measured by pulmonary arterial hypertension), functional status, 6 minute walk test (6MWT), quality of life, mortality, and serious adverse events. RESULTS We included three studies. One RCT and two single-arm interventional observational studies. The RCT had a high risk of bias whereas the two single-arm interventional studies were graded as fair quality. Meta-analysis could not be conducted because of insufficient data. The RCT showed significant improvements in hemodynamics (as measured by pulmonary arterial pressures) and functional status. One observational study showed improvements in hemodynamics, functional status, and 6MWT. There were insufficient data for serious adverse events, mortality, and quality of life. CONCLUSIONS Despite a high prevalence and with a poor prognosis, there is a paucity of data for the role of immunosuppression in the treatment of Group 1 Pulmonary Arterial Hypertension in SLE. More high-quality studies are needed, especially to investigate serious adverse events and quality of life.
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Affiliation(s)
- Sebastian Bruera
- Section of Immunology, Allergy and Rheumatology, Baylor College of Medicine, Houston, Texas, USA
| | - Arsha Sreedhar
- Department of Emergency Medicine, McGovern Medical School, Houston, Texas, USA
| | - Sandeep K Agarwal
- Section of Immunology, Allergy and Rheumatology, Baylor College of Medicine, Houston, Texas, USA
| | - Varsha Muthukumar
- Department of General Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Yimin Geng
- Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Maria A Lopez-Olivo
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Pu D, Yuan H, Ma G, Duan H, Zhang M, Yu N. CT quantitative analysis of pulmonary changes in rheumatoid arthritis. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2023; 31:545-553. [PMID: 36847056 DOI: 10.3233/xst-221329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To explore the application of quantitative computed tomography (CT) in analyses of lung changes in patients with rheumatoid arthritis (RA). METHODS A total of 150 clinically diagnosed RA patients underwent chest CT and 150 matched non-smokers subjects with normal chest CT are enrolled. A CT software is applied to analyze CT obtained from both groups. The quantitative indices of emphysema are expressed as the percentage of lung area with attenuation < -950HU to the total lung volume (LAA-950%), and pulmonary fibrosis was expressed as the percentage of lung area with a attenuation of -200 to -700HU to the total lung volume (LAA-200--700%), quantitative indicators of pulmonary vascular include aortic diameter (AD), pulmonary artery diameter (PAD), the ratio of PAD to AD (PAD/AD ratio), the number of blood vessels (TNV), and the cross area of blood vessels (TAV). The receiver operating characteristic (ROC) curve is used to evaluate the ability of these indexes in identifying the changes in the lung in RA patients. RESULTS Compared to the control group, the RA group has significantly lower TLV, larger AD, and smaller TNV and TAV (3921±1101 vs. 4490±1046, 33.26±4.20 vs. 32.95±3.76, 13.14±4.93 vs. 17.53±3.34, and 96.89±40.62 vs. 163.32±34.97, respectively, with all p < 0.001). Peripheral vascular indicator TAV has the better ability to identify lung changes in RA patients (area under ROC curve AUC = 0.894) than TNV (AUC = 0.780) or LAA-200 &sim-700% (AUC = 0.705). CONCLUSION Quantitative CT can detect changes in lung density distribution and peripheral vascular injury in patients with RA and assess the severity.
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Affiliation(s)
- Doudou Pu
- School of Medical Technology, Shaanxi University of Chinese Medicine, Xian Yang, China
| | - Hui Yuan
- Department of Rheumatology Immunohematology, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xian Yang, China
| | - Guangming Ma
- Department of Medical Imaging, Affiliated Hospitalof Shaanxi University of Chinese Medicine, Xian Yang, China
| | - Haifeng Duan
- Department of Medical Imaging, Affiliated Hospitalof Shaanxi University of Chinese Medicine, Xian Yang, China
| | - Min Zhang
- Department of Medical Imaging, Affiliated Hospitalof Shaanxi University of Chinese Medicine, Xian Yang, China
| | - Nan Yu
- School of Medical Technology, Shaanxi University of Chinese Medicine, Xian Yang, China
- Department of Medical Imaging, Affiliated Hospitalof Shaanxi University of Chinese Medicine, Xian Yang, China
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Muacevic A, Adler JR, Muthiah K, Pallipamu N, Taheri S, Thiagaraj SS, Shukla TS, Gutlapalli SD, Giva S, Penumetcha SS. Increased Risk of Cardiovascular Diseases in Rheumatoid Arthritis: A Systematic Review. Cureus 2022; 14:e32308. [PMID: 36632250 PMCID: PMC9827945 DOI: 10.7759/cureus.32308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/08/2022] [Indexed: 12/13/2022] Open
Abstract
Rheumatoid arthritis (RA) is an autoimmune condition in which the body's joints are attacked by the immune system, leaving the patient disabled in severe cases, with irreversible joint damage and a lower quality of life. RA patients are more likely to develop cardiovascular (CV) disease, which increases their risk of morbidity and mortality. This study systematically reviews various CV diseases that might occur with RA including heart failure (HF), coronary artery disease, acute coronary syndrome, ischemic heart disease, stroke, cardiac death, venous thromboembolism, and valvular diseases. The relation between these complications and RA is specifically assessed. Systematic search was carried out on literature reporting the risk of each of the CV diseases in RA patients from databases in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The databases searched were MEDLINE (through PubMed) and Google Scholar using a combination of keywords and medical subject headings (MeSH). Our keywords were mainly "cardiovascular diseases" and "arthritis and rheumatoid". We found a total of 33 articles reporting each CV comorbidity. Interestingly, a wide spectrum of CV diseases is reported in patients with RA. Many tools were implemented in the diagnosis of each disease such as carotid intima-media thickness for atherosclerosis and echocardiography for HF. We confirmed that RA is associated with an increased risk of different CV events, and prophylactic measures should be implemented.
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Zhao J, Wang Q, Deng X, Qian J, Tian Z, Liu Y, Li M, Zeng X. The treatment strategy of connective tissue disease associated pulmonary arterial hypertension: Evolving into the future. Pharmacol Ther 2022; 239:108192. [DOI: 10.1016/j.pharmthera.2022.108192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 04/07/2022] [Accepted: 04/18/2022] [Indexed: 11/30/2022]
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Lin CH, Wong LT, Hsu JY, Chao WC. Relationship between exposure to ozone and exacerbation requiring hospital admission among patients with asthma: a case-control study in central Taiwan. BMJ Open 2022; 12:e050861. [PMID: 35165108 PMCID: PMC8845173 DOI: 10.1136/bmjopen-2021-050861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE The convergence of asthma and air pollutants in ageing populations is currently a growing health issue worldwide, and hence there is an essential need to investigate the association between exposure to air pollution, particularly ozone (O3), and exacerbation requiring admission in patients with asthma. SETTING A case-control study at a tertiary referral hospital in central Taiwan. PARTICIPANTS We used an asthma cohort, which included 11 400 patients with asthma, for the period 2006-2018 at Taichung Veterans General Hospital. PRIMARY AND SECONDARY OUTCOME MEASURES We identified patients who had admitted for exacerbation as cases and selected patients with asthma without exacerbation, matching (1:4) the cases for age, gender and season of exacerbation, as controls. Data on hourly level of air pollutants were obtained from the Taiwan Environmental Protection Administration. We used conditional logistic regression and calculated adjusted ORs (adjORs) with 95% CIs. RESULTS We enrolled 11 400 participants with asthma, and 4.4% (501) of them had been admitted for exacerbation. Participants with asthma with exacerbation requiring hospitalisation were exposed to a higher level of O3 8-hour daily maximum (adjOR 1.009, 95% CI 1.001 to 1.016) and were more likely to have high Charlson Comorbidity Index (CCI ≥3; adjOR 2.198, 95% CI 1.729 to 2.794) and asthma-chronic obstructive pulmonary disease overlap (adjOR 4.542, 95% CI 3.376 to 6.611) compared with those without exacerbation. The aforementioned associations between exacerbation of asthma requiring hospitalisation and exposure to O3 were similar when defined by either O3 1-hour daily maximum or O3 24-hour average. Moreover, the O3 relevant exacerbation of asthma mainly existed in those aged older than 65 years and patients with medical comorbidities, including gastrointestinal diseases, cardiovascular diseases, neurological diseases, diabetes and renal disease. CONCLUSIONS Our findings highlight the need for vigilance of exposure to O3 among elderly with asthma, particularly those with medical comorbidities. Further studies are warranted to investigate the underlying mechanisms.
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Affiliation(s)
- Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Healthcare Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
- Department of Public Health, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
- Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan
| | - Li-Ting Wong
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Jeng-Yuan Hsu
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Physical Therapy, Chung-Shan Medical University, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Wen-Cheng Chao
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Colledge of Medicine, Chung Hsing University, Taichung, Taiwan
- Big Data Center, Chung Hsing University, Taichung, Taiwan
- Department of Automatic Control Engineering, Feng Chia University, Taichung, Taiwan
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