Air Particulate Exposure Associated With Pediatric Lupus Activity

Exposure to certain fine particulate matter in air pollution was associated with increased severity of lupus disease activity in pediatric patients, according to an abstract from researchers in Brazil presented at the European League Against Rheumatism (EULAR) 2016 Annual Congress held in London, UK.¹  These results were the first to suggest that air pollution may trigger systemic lupus erythematosus (SLE) disease activity.

Particles less than 2.5 micrometers in diameter (PM_2.5) are referred to as “fine” particles and are believed to pose the greatest health risks, owing in part to their ability to lodge deeply in lung tissue once inhaled. An increase in the daily PM_2.5 concentration by 18.12 µg/m³ was found to be associated with significant increases in Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) scores in pediatric patients in Brazil.

Prior research associated pollution exposure with increased pediatric rheumatic disease hospital admissions. Data from this abstract presented by Maria Fernanda Goulart, MD, of the Department of Pediatric Rheumatology, at the University of São Paulo, Brazil, was the first to show that a standard measure of moderate-to-severe SLE disease activity, measured by SLEDAI-2K≥8,  was increased at 4 and 11 days after exposure to PM_2. particulate concentrations increased by 18.12 µg/m^3.

The increase in SELDAI-2K scores were accompanied by increases in fractional concentration of exhaled nitric oxide and acidified exhaled breath condensate at day 7 and 10 post-exposure, suggesting increased airway inflammation temporally related to exposure to the pollution particulate matter.

It is interesting to note that the rate of pediatric patients with SLE presenting for evaluation of acute respiratory symptoms did not increase.

Summary and Clinical Applicability

Exposure to specific particulate air pollution may play a role in triggering worsening SLE disease activity in children in Brazil. 

“Our findings have shown that air pollution.. is also an important contributory factor in childhood rheumatic diseases, such as lupus,” said Dr Goulart. “With air pollution increasing in many major cities, pediatric rheumatologists can expect to see a resultant impact on the disease activity of their lupus patients”.

Limitations and Disclosures

This data provided temporal association between exposure to certain particulate matter and increases in SLE activity, however causality was not directly demonstrated. This research was presented in abstract form, full-length article publication following additional peer-review is pending. 

Reference

1. Air pollution exposure may worsen lupus In children. Abstract Number: OP0220. Presented at the 2016 Annual Congress of the European League Against Rheumatism (EULAR). London, England.