The effects of pollution (such as that shown here in Beijing, China) do not appear until later in the RA disease process.
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Rheumatic diseases are intrinsically linked to environmental conditions. With a constantly changing environment, how can rheumatologists adapt to the challenges of global climate change, pollution and other environmental threats?
The Environment + Genetics
Tamiko Katsumoto, MD, a clinical associate professor in the Division of Immunology and Rheumatology at Stanford University, Palo Alto, Calif., emphasizes the role of environment in addition to genetics as risk factors for the development of autoimmunity. She notes that there has been an increase in positive ANA titers, along with many rheumatic diseases and speculates on how environment plays a role in this.
Overall, the environment is estimated to play a role in about 80% of diseases. With Thomas Bush, MD, Dr. Katsumoto compiled data from 87 studies linking rheumatic diseases to air pollution, among which 74 showed associations with increased disease activity or disease incidence.1 She also notes that the range of arthritogenic infections has been expanding with climate change, such as dengue, chikungunya, Lyme disease and coccidiomycosis.
In addition to climate change, greater exposure to pollutants may be impacting disease activity. Persistent organic pollutants, from such sources as pesticides, industrial chemicals and chemical byproducts, tend to be lipid soluble, leading to bioaccumulation. Many of these POPs are endocrine disrupting chemicals. These endocrine disruptor chemicals have been associated to various degrees with autoimmune disease.
Dr. Katsumoto emphasizes the role of food in fueling autoimmunity and as an intervention to confront environmental threats. Prior research has shown that a higher cumulative ingestion of ultraprocessed food is associated with lupus. The Plants for Joints study showed a plant-based diet may help reduce symptoms in rheumatoid arthritis and osteoarthritis. To expand upon this, preliminary results from the Stanford PLANT study (Providers Learning About Nutrition Together) demonstrate that education for providers may help to educate patients on these benefits. Additionally, due to the energy expenditures in raising meat and dairy, a plant-based diet may be a practical way to address environmental threats.
Air Pollution
Sasha Bernatsky, MD, PhD, a rheumatologist with a PhD in epidemiology, and a James McGill professor of medicine at the Research Institute of the McGill University Health Centre, Montréal, further expands on the effects of air pollution on autoimmune disease. Air pollution is a major issue, with greater than 90% of the global population breathing air that exceeds WHO guideline limits, and over 85 million Americans living in areas where air pollution exceeds air quality standards, she said. Pollutants are heterogeneous, including gases and particulate matter that can penetrate airways and be absorbed into the body, leading to oxidative stress, inflammation, and immune system activation.
