Running Title: Rheumatoid arthritis and short-term pollutants exposure
RHEUMATOID ARTHRITIS ACTIVITY AND SHORT-TERM EXPOSURE TO AIR POLLUTANTS
IN METROPOLITAN AREAS IN THE NORTH OF ITALY
Francesca Ingegnoli 1,2, ORCID 0000-0002-6727-1273,
@IngegnoliFra
Tania Ubiali 1,
Tommaso Schioppo 1,2, ORCID 0000-0001-8359-5131
Valentina Longo 1,
Antonella Murgo 1,
Orazio De Lucia 1, ORCID 0000-0003-2304-6661
Ennio Giulio Favalli 1, ORCID 0000-0003-1471-6467
Simona Iodice 3,
Valentina Bollati 2,3, ORCID 0000-0002-0370-9598
Roberto Caporali 1,2, ORCID 0000-0001-9300-6169
1Division of Clinical Rheumatology, ASST Pini-CTO,
Milano, Italy
2Dept of Clinical Sciences & Community Health,
Research Center for Adult and Pediatric Rheumatic Diseases, Research
Center for Environmental Health, Università degli Studi di Milano,
Milano, Italy
3EPIGET – Epidemiology, Epigenetics and Toxicology
Lab, Dept of Clinical Sciences & Community Health, Università degli
Studi di Milano, Milano, Italy
Corresponding author :
Francesca Ingegnoli
Department of Clinical Sciences and Community Health,
Division of Clincal Rheumatology, ASST Pini-CTO, Università degli Studi
di Milano,
Piazza Cardinal Ferrari 1, 20122 Milano, Italy
Tel: +39 02 5829 6456
Fax: +39 02 5829 6804
E-mail: francesca.ingegnoli@unimi.it
ABSTRACT
Background. Rheumatoid arthritis (RA) flare is related to an
increased joint damage, disability and healthcare use. The impact of
short-term air pollution exposure on RA activity is still a matter of
debate. We investigated in a cross-sectional study whether short-term
exposure to particulate matter (PM)10,
PM2.5, nitrogen dioxide (NO2) and ozone
(O3) affected RA disease activity.
Methods. 422 consecutive RA patients resident in Lombardy,
North of Italy were studied. Air pollutant concentrations, estimated by
Regional Environmental Protection Agency (Lombardy – Italy) at
municipality resolution, were used to assign short-term exposure from
the day of visit back to 14 days.
Results . Sparse punctual significant negative associations
emerged between PM10, PM2.5,
NO2 and RA disease activity, whereas positive
associations were observed for O3. Moreover, patients
were stratified according to their ongoing Disease Modifying
anti-Rheumatic Drugs (DMARDs) treatment: no DMARDs (n=25), conventional
synthetic - csDMARDs (n=108), and biological or targeted synthetic
b/tsDMARDs (n=289). At visit, an inverse association was observed in the
b/tsDMARDs group between PM2.5 and Disease Activity
Score on 28 joints (DAS28) (-0.047±0.020, p =0.023), a positive
tendency in the no-DMARD group (0.125±0.070, p =0.075) and no
association for csDMARDs group (0.042±0.039, p =0.288). The
association between O3 the day before the visit and
DAS28 was positive only in the b/tsDMARDs group (0.038±0.009,p <0.001).
Conclusion. The impact of air pollution short-term exposure
seems minimally clinical relevant, as the scattered significant
differences were observed. Further evidence is needed to elucidate
determinants of RA flare and the implications for management.