Environmental Factors in Pediatric Systemic Autoimmune Diseases

Studies in other pediatric autoimmune diseases are smaller, with antecedent infection and short-term exposure to ultra­violet radiation prior to diagnosis as emerging risk factors for subgroups of patients with JDM. Air pollution may increase disease activity in pediatric SLE and other systemic autoimmune diseases, but such findings need to be confirmed.

Future investigations in this area will require adequately powered and controlled studies, examination of well-defined subgroups of patients whose risk factors may differ from the disease overall and confirmation of exposures through medical record review or validated biomarkers. Challenges include difficulties in assessing environmental exposures outside traditional medical system reporting and reporting biases in questionnaire studies. Also, the timing of exposures in relation to disease onset, the effects of intensity vs. duration of exposures, potential gender and age differences, interactions of multiple exposures and genetic factors and assessing mechanisms are all important areas for future investigations.

Many environmental exposures have not yet been investigated as possible risk factors for autoimmunity in children and should be prioritized based on animal model and in vitro data and identified risk factors in the adult-onset systemic autoimmune diseases. In addition, study designs that include populations with high levels of exposures in certain geographic regions or after accidental exposures may be productive.

Uncovering modifiable environmental factors for pediatric systemic autoimmune diseases will not only help with our understanding of disease mechanisms, but also help guide treatments and even potentially aide in the prevention of these diseases.

Lisa G. Rider, MD, is a pediatric rheumatologist and deputy chief of the Environmental Autoimmunity Group at the National Institute of Environmental Health Sciences, National Institutes of Health at the Clinical Research Center in Bethesda, Maryland. Her research has focused on juvenile myositis, including studies on environmental risk factors.

Frederick W. Miller, MD, PhD, is an adult rheumatologist and immunologist and is chief of the Environmental Autoimmunity Group at the National Institute of Environmental Health Sciences, National Institutes of Health at the Clinical Research Center in Bethesda, Maryland. He has focused on adult myositis and systemic rheumatic diseases, leading studies and working groups on environmental and genetic risk factors for these diseases in adults and children.

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Disclosures

This research was supported by the Intramural Research Program of the NIH, National Institute of Environmental Health Sciences.