Air Pollution Linked to Pediatric Lupus

A new study shows an association between daily exposure to air pollutants and disease activity in children with childhood-onset systemic lupus erythematous (cSLE), researchers reported this week at the annual meeting of the European League Against Rheumatism Annual Congress (EULAR 2016) in London.

The study was conducted by a research team in Brazil that previously published work showing that children exposed to air pollutants at greater levels had higher rates of hospitalizations associated with pediatric rheumatic diseases, in particular, childhood-onset systemic lupus erythematous (cSLE).

“Our findings have shown that air pollution doesn’t just increase the incidence and prevalence of chronic lung disease and acute respiratory infections, lung cancer, heart disease and strokes, it is also an important contributory factor in childhood rheumatic diseases, such as lupus,” the study’s lead author, Maria Fernanda Goulart, M.D., of the University of Sao Paulo, said in a news release. “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.”  [[{"type":"media","view_mode":"media_crop","fid":"49334","attributes":{"alt":"©SoloviovaLiudmyla/Shutterstock.com","class":"media-image media-image-right","id":"media_crop_8926758745890","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"5945","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"font-size: 13.008px; line-height: 1.538em; float: right;","title":"©SoloviovaLiudmyla/Shutterstock.com","typeof":"foaf:Image"}}]]

The study is based on a longitudinal panel of 108 hospital visits from children with lupus. Over the course of four weeks, researchers measured levels of nitrogen dioxide (NO2), fine particulate matter (PM2,5), ambient temperature and humidity. The measurements were taken every 2.5 months over one year while they collected pH of exhaled breath condensate (EBC pH), fractional exhaled NO (FeNO) and disease activity parameters each week.

Using a standard measure of moderate to severe lupus disease activity (SLEDAI-2K* ≥ 8), an increase of 18.12 ug/m in the daily concentration of the most dangerous of the airborne pollution particles PM2.5 was associated with a significant increase in lupus activity at four and 11 days after exposure. This increase in disease severity may be reflected in worsening of a variety of laboratory findings, mainly renal (proteinuria, haematuria, leukocyturia) and haematological (thrombocytopenia and leukopenia) involvement.

Measurement of two biomarkers after exposure to an increase in PM2.5 showed a significant acidification of exhaled breath condensate at days seven and 10, and an increase in fractional concentration of exhaled nitric oxide, both of which suggest a significant increase in airway inflammation related to air pollution. Despite this worsening airway inflammation, children and adolescents with SLE didn’t present any evidence of an increase in acute respiratory symptoms.

References:

M.F.G. Goulart, A.G.F. Alves, et. al. "Personal Exposure to Air Pollution Influenced Disease Activity and Exhaled Breath Biomarkers:  A Prospective Study in a Childhood Onset Lupus Erythematosus." EULAR 2016. Abstract number:  OP0220