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Exposure-lag-response associations between extreme environmental conditions and primary Sjögren’s syndrome

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Abstract

Introduction

Patients with primary Sjögren’s syndrome (pSS) reportedly believe that their symptoms worsen on extreme weather days due to variations in environmental conditions. However, few studies have assessed the acute effects of environmental exposure on the onset of pSS. This study aimed to evaluate the exposure–response relationship between extreme environmental conditions and pSS outpatient visits.

Method

We obtained data on pSS outpatient visits from two provincial general hospitals in Hefei, China, during 2014–2019. A distributed lag non-linear model was used to estimate the exposure-lag-response relationship between environmental variables and pSS.

Results

We detected significant and non-linear associations between extreme environments and pSS. The estimated relative risk (RR) for a lag of 3 days was 1.11 (95% CI: 1.03 to 1.19) for extreme cold and for a lag of 21 days was 1.07 (95% CI: 1.01 to 1.12) for extreme dampness. Long sunshine duration was positively correlated with pSS (lag 11, 1.05, 95% CI: 1.01 to 1.08). Moreover, female patients were more susceptible to these effects. Patients older than 65 years old were more vulnerable to frigid environments (lag 3, RR = 1.30, 95% CI: 1.09 to 1.54), while younger patients were more vulnerable to extreme dampness (lag 21, RR = 1.10, 95% CI: 1.03 to 1.16). Extreme cold and high humidity were negatively correlated with the same-day outpatient visits.

Conclusions

Our findings suggest a potential relationship between exposure to extreme environmental conditions and increased risk of pSS outpatient visits. We therefore suggest that policymakers and doctors aim to further our understanding of environmental effects on pSS and adopt adequate measures to alleviate pSS symptoms.

Key Points

• Extreme cold, extreme dampness, and long sunshine duration increased the risk of pSS outpatient visits, especially for females.

• Young pSS patients are more susceptible to a rise in humidity.

• Elderly pSS patients are more sensitive to extreme cold weather.

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Data availability

The datasets used and/or analysed during the current study are available from the corresponding author upon reasonable request.

Code availability

The code used in this study is available from the corresponding author upon reasonable request.

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Acknowledgements

The authors would like to thank all colleagues who contributed to this study.

Funding

This study was supported by the key projects of the Anhui Provincial Department of Education (KJ2019A0439, KJ2020A0394) and Key Laboratory of Xin’an Medicine of the Ministry of Education (2020XAYX08).

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Authors and Affiliations

  1. The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, China

    Ling Xin, Jian Liu & Yanyan Fang

  2. University of Science and Technology of China, Hefei, Anhui, China

    Yongjian Zhu

  3. Technical University of Munich, Heilbronn, Germany

    Jingui Xie

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  1. Ling Xin
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  3. Jian Liu
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Contributions

Liu and Xie conceived and designed the study; Xin wrote the manuscript; Zhu analysed the data; Fang collected subjects and clinical data. All authors read and approved the final manuscript.

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Correspondence to Jian Liu.

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Xin, L., Zhu, Y., Liu, J. et al. Exposure-lag-response associations between extreme environmental conditions and primary Sjögren’s syndrome. Clin Rheumatol 41, 523–532 (2022). https://doi.org/10.1007/s10067-021-05910-5

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