Public Release: 

Air pollution exposure may worsen lupus in children

Not just a respiratory and cardiovascular issue

European League Against Rheumatism

London, United Kingdom, 8 June 2016: The results of a study presented today at the European League Against Rheumatism Annual Congress (EULAR 2016) show for the first time that an individual's exposure to air pollution may have a direct role in triggering disease activity as well as airway inflammation in children and adolescents with Systemic Lupus Erythematosus (SLE). This study, conducted in Brazil, has confirmed a direct link between an individual's personal exposure to fine pollution particles and their lupus disease activity.

Previous studies have shown that exposure of a population to outdoor pollutants was associated with an increase in hospital admissions due to paediatric rheumatic diseases, as well as a higher risk of disease activity in those patients attending a hospital with childhood-onset SLE.

Air pollution is a major health issue in Brazil, killing around 49,000 Brazilians every year as a result of its direct link to respiratory and cardiovascular disease, and cancer. Deaths from both outdoor and indoor air pollution represent one in every 26 deaths from all causes in Brazil, making it the ninth largest mortality risk in the country. The WHO has estimated that one in eight of total deaths globally are the result of air pollution exposure, confirming air pollution as the world's largest single environmental health risk. Air pollution is estimated to cause nearly half a million premature deaths each year in the European Union. In busy cities, where air quality is usually at its worst, the average life expectancy of people is reduced by over two years.

"Our findings have shown that air pollution doesn't just increase the incidence and prevalence of chronic lung disease and acute respiratory infections, lung cancer, heart disease and strokes, it is also an important contributory factor in childhood rheumatic diseases, such as lupus," said Dr Maria Fernanda Goulart from the Department of Paediatric Rheumatology, University of São Paulo, Brazil. "With air pollution increasing in many major cities, paediatric rheumatologists can expect to see a resultant impact on the disease activity of their lupus patients," she added.

Using a standard measure of moderate to severe lupus disease activity (SLEDAI-2K ? 8), an increase of 18.12 μg/m3 in the daily concentration of the most dangerous of the airborne pollution particles PM2.5 was associated with a significant increase in lupus activity at four and 11 days after exposure. This increase in disease severity may be reflected in worsening of a variety of laboratory findings, mainly renal (proteinuria, haematuria, leukocyturia) and haematological (thrombocytopenia and leukopenia) involvement.7

Measurement of two biomarkers after exposure to an increase in PM2.5 showed a significant acidification of exhaled breath condensate at days seven and 10, and an increase in fractional concentration of exhaled nitric oxide, both of which suggest a significant increase in airway inflammation related to air pollution. Despite this worsening airway inflammation, children and adolescents with SLE didn't present any evidence of an increase in acute respiratory symptoms.

Abstract Number: OP0220

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NOTES TO EDITORS:

For further information on this study, or to request an interview with the study lead, please do not hesitate to contact the EULAR congress Press Office in London Suite at ExCel London during EULAR 2016 or on:
Email: eularpressoffice@cohnwolfe.com
Onsite tel: +44 (0) 7725 915 492 / +44 (0) 7786 171 476
Twitter: @EULAR_Press
Youtube: Eular Pressoffice

About EULAR

The European League Against Rheumatism (EULAR) is an umbrella organisation which represents scientific societies, health professional associations and organisations for people with Rheumatic Musculoskeletal Diseases (RMD) throughout Europe.

EULAR aims to promote, stimulate and support the research, prevention, and treatment of RMD and the rehabilitation of those it affects.

EULAR underlines the importance of combating rheumatic diseases not only by medical means, but also through a wider context of care for rheumatic patients and a thorough understanding of their social and other needs. EULAR is supported in this mission by its 45 scientific member societies, 36 PARE (People with Arthritis/Rheumatism in Europe) organisations, 22 HPR (Health Professionals in Rheumatology) associations and 23 corporate members.

The EULAR Annual European Congress of Rheumatology is the foremost international medical meeting announcing the latest research on rheumatic and musculoskeletal diseases. EULAR 2016 is expected to attract over 14,000 delegates from around 120 countries. Most if not all professions working in the vast field of RMD will be represented.

To find out more about the activities of EULAR, visit: http://www.eular.org

References

1. EULAR 2016; London: Abstract OP0220

2. Vidotto JP, Pereira LAA, Braga ALF et al. Atmospheric pollution: influence on hospital admission in pediatric rheumatic disease. Lupus. 2012; 21: 526-33

3. Fernandes EC, Silva CA, Braga ALF, et al. Exposure to air pollutants and disease activity in juvenile-onset systemic lupus erythematosus patients. Arthritis Care Res (Hoboken). 2015; 67 (11): 1609-14

4. Brazil Perspectives: Air Pollution. http://www.copenhagenconsensus.com/publication/brazil-perspectives-air-pollution. [Accessed 28 April 2016]

5. 7 million premature deaths annually linked to air pollution http://www.who.int/mediacentre/news/releases/2014/air-pollution/en/ [Accessed 3 May 2016]

6. European City Ranking 2015: Best practices for clean air in urban transport http://sootfreecities.eu/ [Accessed 3 May 2016]

7. Gladman DD, Ibanez D, Urowitz MB. Systemic lupus erythematosus disease activity index 2000. J Rheumatol. 2002; 29: 288-91

8. Laumbach RJ, Kipen HM. Acute effects of motor vehicle traffic-related air pollution exposures on measures of oxidative stress in human airways. Annals of the New York Academy of Sciences. 2010; 1203: 107-112

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