Reply to comment by Kao et al on "An overview of the relationship between juvenile idiopathic arthritis and potential environmental risk factors: Do early childhood habits or habitat play a role in the affair?".

In our study, in which the relationship between juvenile idiopathic arthritis (JIA) and particular environmental factors was evaluated, a correlation could not be established between the rate or duration of breastfeeding and the development or severity of the disease. Int J Rheum Dis, 25, 2022, 1376. It was determined that the time of introduction to cow's milk differed in JIA and juvenile-onset systemic lupus erythematosus patient groups compared to healthy controls. On the other hand, the fact that income level and maternal literacy were associated with high disability and damage scores and frequent recurrence rates stood as one of the remarkable results of our study. Kao et al drew attention to the relationship between socioeconomic status and chronic arthritis and quoted an adult study. The role of the parent factor has been stressed and the effect of maternal stress on disease development has been discussed. Although JIA is a heterogeneous disease and the tribulation of measuring the direct impact of environmental elements are limiting factors, it is essential to determine the parts that can be controlled to some extent and the precautions to be taken.