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Exposure to ambient air pollution and autoantibody status in rheumatoid arthritis

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Clinical Rheumatology Aims and scope Submit manuscript

Abstract

Objective

To evaluate the relationship between air pollutant (AP) exposure and rheumatoid arthritis (RA) autoantibody status

Methods

We performed a cross sectional study utilizing enrollment data from participants in the Veterans Affairs rheumatoid arthritis registry. HLA-DRB1 shared epitope (SE), smoking, rheumatoid factor (RF), and anti-cyclic citrullinated peptide antibody (ACPA) status were collected. Mean exposure levels were obtained for AP (NO2, SO2, particulate matter [PM2.5, PM10], and ozone) from air quality monitoring stations at patients’ residential zip codes in the year prior to enrollment. Multivariable logistic and ordinary least squares regression models were used to determine independent associations of AP with RA seropositivity and autoantibody concentration.

Results

The cohort included 557 veterans (90% male, 76% Caucasian), with mean age of 70 years and mean disease duration of 13 years. The majority were HLA-DRB1 SE, RF, and ACPA positive (73%, 79%, and 76%, respectively). In univariate models, PM2.5 exposure was associated with higher ACPA concentration (p = 0.009). Similarly, in multivariable regression models, PM2.5 exposure was independently associated with higher ACPA concentration (p = 0.037). Current smoking independently predicted RF and ACPA positivity and titers, while HLA-DRB1 SE alleles were associated with RF positivity and ACPA positivity and titers.

Conclusions

In an elderly cohort of RA patients, fine particulate matter (PM2.5) exposure independently predicted higher ACPA concentration. Further study of fine particulate matter in the pathogenesis of RA is warranted.

Key Points

• A study that integrates both genetic and environmental exposure data, relative to RA autoantibody status.

• Of different air pollutants measures, exposure to fine particulate matter (PM2.5) appears to be most closely linked to ACPA titers.

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Availability of data and materials

The datasets generated during and/or analyzed during the current study are not publicly available as it contains confidential patient information but are available from the corresponding author on reasonable request.

Abbreviations

AP :

air pollutants

RA :

rheumatoid Arthritis

SE :

shared epitope

RF :

rheumatoid factor

ACPA :

anti-cyclic citrullinated peptide antibody

SLE :

systemic lupus erythematosus

VARA :

veterans affairs rheumatoid arthritis

VA :

veterans affairs

NO 2 :

nitrogen dioxide

SO 2 :

sulfur dioxide

PM 2.5 :

particulate matter size (diameter) generally less than 2.5 micrometers (μm)

PM 10 :

particulate matter size (diameter) generally less than 10 micrometers (μm)

SLAMS :

state or local air monitoring stations

SES :

socioeconomic status

JIA :

juvenile idiopathic arthritis

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Acknowledgements

Bryant R. England, MD, VA Nebraska-Western Iowa Health Care System and the University of Nebraska Medical Center.

Richard Amdur, PhD, Lead Biostatistician, Medical Faculty Associates, Clinical Professor, Dept. of Surgery, George Washington University School of Medicine & Health Sciences.

Funding

The Veterans Affairs Rheumatoid Arthritis Registry (VARA) has received funding from: Nebraska Arthritis Outcomes Research Center at the University of Nebraska Medical Center; Veterans Affairs Health Services Research and Development Program of the Veterans Health Administration (HSR&D), Veterans Health Administration (Veterans Affairs Merit award); HSR&D Career Development Award, Grant Number: CDA 07-221. No financial or non-financial conflicts of interest exist for any of the authors.

Author information

Authors and Affiliations

  1. Rheumatology, MedStar Georgetown University Hospital, 3800 Reservoir St NW, 3PHC, Suite, Washington, DC, 20007, USA

    Asha M. Alex & Gail S. Kerr

  2. Rheumatology, DC VA Medical Center, 50 Irving St, NW, Suite 151K, Washington, DC, 20422, USA

    Asha M. Alex, Jorge D. Flautero Arcos & Gail S. Kerr

  3. Rheumatology, Clinic 2, University of Utah Hospital, Salt Lake City, UT, 84132, USA

    Gary Kunkel

  4. Department of Biostatistics, University of Nebraska Medical Center, 984375, Omaha, NE, 68198-4375, USA

    Harlan Sayles & Ted R. Mikuls

  5. Rheumatology, Howard University, 2400 Sixth St NW, Washington, DC, 20059, USA

    Gail S. Kerr

Authors
  1. Asha M. Alex
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  2. Gary Kunkel
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Contributions

Asha Alex: Contributed to the study conception, design, data acquisition, analysis, interpretation of data, drafted and approved the manuscript and agrees to be accountable for my contributions.

Gary Kunkel: Contributed to data acquisition, concept, interpretation of data, reviewed, approved and modified the manuscript and agrees to be accountable for his contributions.

Harlan Sayles: Contributed to the design of the work, data analysis, interpretation of data, approved and modified the final version and agrees to be accountable for his contributions.

Jorge D. Flautero Arcos: Contributed to data acquisition, concept, interpretation of data, reviewed, approved and modified the manuscript and agrees to be accountable for his contributions.

Ted Mikuls: Contributed to study design, data analysis, reviewed, approved and modified the manuscript and agrees to be accountable for his contributions.

Gail S Kerr: Contributed to the study conception, design, interpretation of data, reviewed, modified and approved the manuscript and agrees to be accountable for her contributions.

Corresponding author

Correspondence to Gail S. Kerr.

Ethics declarations

All VARA sites have approval from their respective Institutional Review Boards, as well as by the VARA Scientific Ethics Advisory Committee.

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Alex, A.M., Kunkel, G., Sayles, H. et al. Exposure to ambient air pollution and autoantibody status in rheumatoid arthritis. Clin Rheumatol 39, 761–768 (2020). https://doi.org/10.1007/s10067-019-04813-w

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  • DOI: https://doi.org/10.1007/s10067-019-04813-w

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