Sahebari Maryam, Esmailpour Maryam, Esmaili Habibollah, Orooji Arezoo, Dowlatabadi Yousef, Nabavi Mahali Shima, Rajabi Enayat, Salari Masoumeh
Rheumatic Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Med J Islam Repub Iran. 2023 Jun 12;37:65. doi: 10.47176/mjiri.37.65. eCollection 2023.
Environmental exposures and genetic predisposition interactions may result in autoimmune rheumatic diseases. This study aimed to determine the effect of outdoor air pollutants on the activity of rheumatoid arthritis (RA) in a longitudinal follow-up.
We longitudinally studied 50 patients with RA bimonthly over 6 months in Mashhad, one of the most polluted cities in Iran. Disease activity and health-related quality of life (HRQoL) were examined according to the disease activity score (DAS28ESR), health assessment questionnaires (HAQ), physical health component summary (PCS), and visual analogue scale (VAS) criteria. The outdoor air pollutant was measured by monitoring the average concentration of nitrogen oxide (NO), carbon monoxide (CO), O level, Sulfur dioxide (SO), and some particles less than 10 and 2.5 micrometers in diameter (PM <10 µm, PM <2.5 µm). The temperature and humidity levels were also measured. The univariate and multivariate statistical analyses were used for data analysis and the role of confounding factors was determined using the generalized estimation equation method.
Statistical analysis indicated a significant increase of the DAS28ESR (B = 0.04 [0.08]; = 0.01) and VAS (B = 4.48 [1.73]; = 0.01) by CO concentration. Moreover, a number of polluted days increased the VAS in patients. In addition, other air pollutants, temperature, and humidity were not affected significantly by the DAS28ESR and quality of life indexes by considering confounders such as medications, age, and job.
Based on our findings, CO concentration was the only effective outdoor air pollutant that could increase RA disease activity. In addition, CO concentration and the number of polluted days make patients feel more ill. As the role of indoor air pollutants is highly important, further research on this critical topic is required to establish the role of air pollution on RA disease activity.
环境暴露与遗传易感性相互作用可能导致自身免疫性风湿性疾病。本研究旨在通过纵向随访确定室外空气污染物对类风湿关节炎（RA）活动的影响。
我们在伊朗污染最严重的城市之一马什哈德，对50例RA患者进行了为期6个月的每两个月一次的纵向研究。根据疾病活动评分（DAS28ESR）、健康评估问卷（HAQ）、身体健康成分总结（PCS）和视觉模拟量表（VAS）标准，对疾病活动和健康相关生活质量（HRQoL）进行了检查。通过监测氮氧化物（NO）、一氧化碳（CO）、O水平、二氧化硫（SO）以及一些直径小于10和2.5微米的颗粒物（PM<10µm，PM<2.5µm）的平均浓度来测量室外空气污染物。还测量了温度和湿度水平。采用单变量和多变量统计分析进行数据分析，并使用广义估计方程法确定混杂因素的作用。
统计分析表明，CO浓度使DAS28ESR（B = 0.04 [0.08]；P = 0.01）和VAS（B = 4.48 [1.73]；P = 0.01）显著增加。此外，污染天数的增加使患者的VAS升高。此外，在考虑药物、年龄和工作等混杂因素的情况下，其他空气污染物、温度和湿度对DAS28ESR和生活质量指标没有显著影响。
根据我们的研究结果，CO浓度是唯一能增加RA疾病活动的有效室外空气污染物。此外，CO浓度和污染天数会使患者感觉病情更严重。由于室内空气污染物的作用非常重要，需要对这一关键课题进行进一步研究，以确定空气污染对RA疾病活动的作用。
