Hospital da Criança, Avenida Juca Sampaio, 67, Jacintinho Maceió, AL, 57042-530, Brazil.
Rheumatology Unit, Child and Adolescent Institute, Hospital das Clínicas, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil.
Adv Rheumatol. 2024 Aug 30;64(1):64. doi: 10.1186/s42358-024-00408-5.
To evaluate the influence of environmental factors and prematurity relating to juvenile dermatomyositis (JDM), its course and refractoriness to treatment.
A case-control study with 35 patients followed up at a tertiary hospital and 124 healthy controls, all residents of São Paulo. Patients were classified according to monocyclic, polycyclic or chronic disease courses and refractoriness to treatment. The daily concentrations of pollutants (inhalable particulate matter-PM, sulfur dioxide-SO, nitrogen dioxide-NO, ozone-O and carbon monoxide-CO) were provided by the Environmental Company of São Paulo. Data from the population were obtained through a questionnaire.
Fifteen patients had monocyclic courses, and 19 polycyclic/chronic courses. Eighteen patients were refractory to treatment. Maternal occupational exposure to inhalable agents (OR = 17.88; IC 95% 2.15-148.16, p = 0.01) and exposure to O in the fifth year of life (third tertile > 86.28µg/m; OR = 6.53, IC95% 1.60-26.77, p = 0.01) were risk factors for JDM in the multivariate logistic regression model. The presence of a factory/quarry at a distance farther than 200 meters from daycare/school (OR = 0.22; IC 95% 0.06-0.77; p = 0.02) was a protective factor in the same analysis. Prematurity, exposure to air pollutants/cigarette smoke/sources of inhalable pollutants in the mother's places of residence and work during the gestational period were not associated with JDM. Prematurity, maternal exposure to occupational pollutants during pregnancy as well as patient's exposure to ground-level pollutants up to the fifth year of life were not associated with disease course and treatment refractoriness.
Risk factors for JDM were maternal occupational exposure and exposure to O in the fifth year of life.
评估环境因素和早产与青少年皮肌炎（JDM）、其病程和对治疗的反应性之间的关系。
这是一项在一家三级医院进行的病例对照研究，共纳入 35 名患者和 124 名健康对照者，所有参与者均居住在圣保罗。根据单环、多环或慢性病程以及对治疗的反应性对患者进行分类。污染物（可吸入颗粒物-PM、二氧化硫-SO、二氧化氮-NO、臭氧-O 和一氧化碳-CO）的日浓度由圣保罗环境公司提供。通过问卷调查获得人群数据。
15 名患者为单环病程，19 名患者为多环/慢性病程。18 名患者对治疗有反应。母亲职业性接触可吸入剂（OR=17.88；95%CI 2.15-148.16，p=0.01）和生命第五年接触 O（第三 tertile>86.28µg/m；OR=6.53，95%CI 1.60-26.77，p=0.01）是多变量逻辑回归模型中 JDM 的危险因素。距离日托/学校 200 米以上有工厂/采石场（OR=0.22；95%CI 0.06-0.77；p=0.02）是同一分析中的保护因素。早产、母亲在妊娠期间接触空气污染物/香烟烟雾/可吸入污染物源以及患者在生命的第五年接触地面污染物与 JDM 无关。早产、母亲在妊娠期间职业性接触污染物以及患者在生命的第五年接触污染物与疾病病程和治疗反应性无关。
JDM 的危险因素是母亲职业性接触和生命第五年接触 O。
