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Seedahmed MI, Albirair MT, Whooley MA, Koth LL, Blanc PD, Arjomandi M. Response. Chest 2024; 165:e25-e26. [PMID: 38199743 PMCID: PMC10925540 DOI: 10.1016/j.chest.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 08/01/2023] [Indexed: 01/12/2024] Open
Affiliation(s)
- Mohamed I Seedahmed
- Medical Service, Pittsburgh Veterans Affairs Healthcare System, Pittsburgh, PA; Division of Pulmonary, Critical Care, Allergy and Immunology, and Sleep, University of Pittsburgh, Pittsburgh, PA; Medical Service, San Francisco Veterans Affairs Healthcare System, San Francisco, CA.
| | | | - Mary A Whooley
- Medical Service, San Francisco Veterans Affairs Healthcare System, San Francisco, CA; Measurement Science Quality Enhancement Research Initiative, San Francisco Veterans Affairs Healthcare System, San Francisco, CA; Departments of Medicine, University of California San Francisco, San Francisco, CA
| | - Laura L Koth
- Departments of Medicine, University of California San Francisco, San Francisco, CA
| | - Paul D Blanc
- Medical Service, San Francisco Veterans Affairs Healthcare System, San Francisco, CA; Departments of Medicine, University of California San Francisco, San Francisco, CA
| | - Mehrdad Arjomandi
- Medical Service, San Francisco Veterans Affairs Healthcare System, San Francisco, CA; Departments of Medicine, University of California San Francisco, San Francisco, CA
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2
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Yamamoto S, Yoshida A, Gono T, Kuwana M. The Role of Environmental Factors in the Development of Idiopathic Inflammatory Myopathies: a Narrative Review. Curr Rheumatol Rep 2023; 25:264-275. [PMID: 37971581 DOI: 10.1007/s11926-023-01120-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE OF REVIEW This review aims to evaluate recent findings on the role of environmental factors in the development and clinical presentation of idiopathic inflammatory myopathies (IIMs). RECENT FINDINGS A targeted literature review was conducted to identify reports relevant to the association between environmental factors and IIMs published over the past three years. There has been an increasing number of publications dealing with the association of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or vaccination with the development of IIMs, highlighting the significant role of the antiviral immune response in the pathogenesis of the disease. Traditional environmental factors associated with the pathogenic process of IIM subclassifications included drugs such as statins and immune checkpoint inhibitors, ultraviolet radiation, smoking, air pollutants, and vitamin D deficiency. Correlations of seasonality and residence with the onset of certain IIM subtypes suggest a potential role of environmental triggers in the pathogenic process. An interplay between genetic predisposition and various environmental factors might contribute to the development of IIMs as well as the heterogeneous clinical and serological presentation of IIMs. The growing evidence on the role of environmental factors in the development of IIMs provides important clues to elucidate the pathophysiology of these disease entities. The mechanisms underlying the interactions between genetic predisposition and environmental factors should be investigated in the future.
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Affiliation(s)
- Shintaro Yamamoto
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8602, Japan
| | - Akira Yoshida
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8602, Japan
| | - Takahisa Gono
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8602, Japan
- Scleroderma/Myositis Center of Excellence, Nippon Medical School Hospital, Tokyo, Japan
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8602, Japan.
- Scleroderma/Myositis Center of Excellence, Nippon Medical School Hospital, Tokyo, Japan.
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3
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Seedahmed MI, Albirair MT, Whooley MA, Koth LL, Blanc PD, Arjomandi M. Screening for Exposure to Beryllium Among US Veterans With a Diagnosis of Sarcoidosis, 2002-2020. Chest 2023; 164:1253-1256. [PMID: 37364853 PMCID: PMC10792292 DOI: 10.1016/j.chest.2023.05.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 05/31/2023] [Accepted: 05/31/2023] [Indexed: 06/28/2023] Open
Affiliation(s)
- Mohamed I Seedahmed
- Medical Service, San Francisco Veterans Affairs Healthcare System, San Francisco, CA; Department of Medicine, University of California San Francisco, San Francisco, CA.
| | | | - Mary A Whooley
- Medical Service, San Francisco Veterans Affairs Healthcare System, San Francisco, CA; Department of Medicine, University of California San Francisco, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA; Measurement Science Quality Enhancement Research Initiative, San Francisco Veterans Affairs Healthcare System, San Francisco, CA
| | - Laura L Koth
- Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Paul D Blanc
- Medical Service, San Francisco Veterans Affairs Healthcare System, San Francisco, CA; Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Mehrdad Arjomandi
- Medical Service, San Francisco Veterans Affairs Healthcare System, San Francisco, CA; Department of Medicine, University of California San Francisco, San Francisco, CA
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4
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Opinc-Rosiak AH, Makowska JS. Environmental exposures as risk factors for idiopathic inflammatory myopathies. J Autoimmun 2023; 140:103095. [PMID: 37797402 DOI: 10.1016/j.jaut.2023.103095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/25/2023] [Indexed: 10/07/2023]
Abstract
Idiopathic inflammatory myopathies (IIM) are a heterogeneous group of rare autoimmune diseases, with increasing incidence rates observed in the recent years. The pathogenesis of IIM remains not fully understood, and the interaction of genetic and environmental factors is suspected. It is unclear whether the observed upward trend in the IIM incidence is solely due to improved access to effective diagnostics or perhaps due to increased exposure to external risk factors. The PUBMED database was thoroughly searched for articles describing environmental exposures potentially triggering the onset of IIM. The article summarizes the current knowledge available on this subject, taking into account various environmental factors, including among others UV radiation, infectious agents with SARS-CoV-2, inhaled particles, or iatrogenic effects. Limitations and unmet needs requiring further studies were highlighted.
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Affiliation(s)
| | - Joanna S Makowska
- Department of Rheumatology, Medical University of Lodz, Zeromskiego 113, 90-549, Lodz, Poland.
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5
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Seedahmed MI, Baugh AD, Albirair MT, Luo Y, Chen J, McCulloch CE, Whooley MA, Koth LL, Arjomandi M. Epidemiology of Sarcoidosis in U.S. Veterans from 2003 to 2019. Ann Am Thorac Soc 2023; 20:797-806. [PMID: 36724377 PMCID: PMC10257030 DOI: 10.1513/annalsats.202206-515oc] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 02/01/2023] [Indexed: 02/03/2023] Open
Abstract
Rationale: United States veterans represent an important population to study sarcoidosis. Their unique history of environmental exposures, wide geographic distribution, and long-term enrollment in a single integrated healthcare system provides an unparalleled opportunity to understand the incidence, prevalence, and risk factors for sarcoidosis. Objectives: To determine the epidemiology, patient characteristics, geographic distribution, and associated risk factors of sarcoidosis among U.S. veterans. Methods: We used data from the Veterans Health Administration (VHA) electronic health record system between 2003 and 2019 to evaluate the annual incidence, prevalence, and geographic distribution of sarcoidosis (defined using the International Classification of Diseases codes). We used multivariate logistic regression to examine patient characteristics associated with sarcoidosis incidence. Results: Among more than 13 million veterans who received care through or paid for by the VHA, 23,747 (0.20%) incident diagnoses of sarcoidosis were identified. Compared with selected VHA control subjects using propensity score matching, veterans with sarcoidosis were more likely to be female (13.5% vs. 9.0%), of Black race (52.2% vs. 17.0%), and ever-tobacco users (74.2% vs. 64.5%). There was an increase in the annual incidence of sarcoidosis between 2004 and 2019 (from 38 to 52 cases/100,000 person-years) and the annual prevalence between 2003 and 2019 (from 79 to 141 cases/100,000 persons). In a multivariate logistic regression model, Black race (odds ratio [OR], 4.49; 95% confidence interval [CI], 4.33-4.65), female sex (OR, 1.64; 95% CI, 1.56-1.73), living in the Northeast compared with the western region (OR, 1.57; 95% CI, 1.48-1.67), history of tobacco use (OR, 1.36; 95% CI, 1.31-1.41), and serving in the Army, Air Force, or multiple branches compared with the Navy (OR, 1.08; 95% CI, 1.03-1.13; OR, 1.10; 95% CI, 1.04-1.17; OR, 1.27; 95% CI, 1.16-1.39, respectively) were significantly associated with incident sarcoidosis (P < 0.0001). Conclusions: The incidence and prevalence of sarcoidosis are higher among veterans than in the general population. Alongside traditionally recognized risk factors such as Black race and female sex, we found that a history of tobacco use within the Veterans Affairs population and serving in the Army, Air Force, or multiple service branches were associated with increased sarcoidosis risk.
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Affiliation(s)
- Mohamed I. Seedahmed
- San Francisco Veterans Affairs Medical Center, San Francisco, California
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine
| | - Aaron D. Baugh
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine
| | - Mohamed T. Albirair
- Department of Global Health, University of Washington, Seattle, Washington; and
| | - Yanting Luo
- San Francisco Veterans Affairs Medical Center, San Francisco, California
- Philip R. Lee Institute for Health Policy Studies
| | - Jianhong Chen
- San Francisco Veterans Affairs Medical Center, San Francisco, California
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine
| | | | - Mary A. Whooley
- San Francisco Veterans Affairs Medical Center, San Francisco, California
- Department of Medicine, University of California San Francisco, San Francisco, California
- Measurement Science Quality Enhancement Research Initiative, San Francisco Veterans Affairs Healthcare System, San Francisco, California
| | - Laura L. Koth
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine
| | - Mehrdad Arjomandi
- San Francisco Veterans Affairs Medical Center, San Francisco, California
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine
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Abstract
PURPOSE OF REVIEW Military personnel deployed to Southwest Asia and Afghanistan were potentially exposed to high levels of fine particulate matter and other pollutants from multiple sources, including dust storms, burn pit emissions from open-air waste burning, local ambient air pollution, and a range of military service-related activities that can generate airborne exposures. These exposures, individually or in combination, can have adverse respiratory health effects. We review exposures and potential health impacts, providing a framework for evaluation. RECENT FINDINGS Particulate matter exposures during deployment exceeded U.S. National Ambient Air Quality Standards. Epidemiologic studies and case series suggest that in postdeployment Veterans with respiratory symptoms, asthma is the most commonly diagnosed illness. Small airway abnormalities, most notably particularly constrictive bronchiolitis, have been reported in a small number of deployers, but many are left without an established diagnosis for their respiratory symptoms. The Promise to Address Comprehensive Toxics Act was enacted to provide care for conditions presumed to be related to deployment exposures. Rigorous study of long-term postdeployment health has been limited. SUMMARY Veterans postdeployment to Southwest Asia and Afghanistan with respiratory symptoms should undergo an exposure assessment and comprehensive medical evaluation. If required, more advanced diagnostic considerations should be utilized in a setting that can provide multidisciplinary expertise and long-term follow-up.
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Affiliation(s)
- Eric Garshick
- Pulmonary, Allergy, Sleep and Critical Care Medicine Section, Veterans Affairs Boston Healthcare System; Harvard Medical School and Brigham and Women’s, Boston, Massachusetts
| | - Paul D. Blanc
- San Francisco VA Medical Center, UC San Francisco School of Medicine, San Francisco; Division of Occupational and Environmental Medicine, Department of Medicine, University of California San Francisco, California, USA
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Morse JL, Afari N, Norman SB, Guma M, Pietrzak RH. Prevalence, characteristics, and health burden of rheumatoid arthritis in the U.S. veteran population. J Psychiatr Res 2023; 159:224-229. [PMID: 36746059 DOI: 10.1016/j.jpsychires.2023.01.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 01/18/2023] [Accepted: 01/26/2023] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To examine the prevalence, characteristics, and physical and mental health burden of rheumatoid arthritis (RA) in a nationally representative sample of U.S. military veterans. METHODS Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study (NHRVS), which surveyed a contemporary, nationally representative sample of 4,069 U.S. veterans. Veterans with RA (n = 227) were compared to veterans with any other medical condition(s) (n = 3,444) on measures of sociodemographic, military, trauma, medical and psychiatric characteristics. Multivariable analyses were then conducted to examine independent associations between RA and health conditions. RESULTS A total of 5.3% (95% confidence interval = 4.5-6.2%) of primarily male U.S. veterans reported having been diagnosed with RA. Relative to controls, veterans with RA were older, and more likely to be racial/ethnic minorities, unpartnered, lower income, and combat veterans. They also reported greater cumulative trauma burden, more medical conditions (i.e., osteoarthritis, chronic pain, respiratory and cardiovascular conditions), and greater severity of somatic symptoms, and were more likely to screen positive for current insomnia and subthreshold posttraumatic stress disorder (PTSD), and lifetime alcohol use disorder (AUD). In adjusted analyses, RA remained associated with number of medical conditions, more severe somatic symptoms, insomnia, subthreshold PTSD, and AUD. CONCLUSIONS One of 20 U.S. veterans has RA, which is more prevalent among certain sociodemographic subsets, and is associated with elevated physical and mental health burden. Results provide insight into risk correlates of RA and underscore the importance of assessing, monitoring, and treating medical and psychiatric conditions/symptoms that co-occur with RA in this population.
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Affiliation(s)
- Jessica L Morse
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, 116, San Diego, CA, 92161, USA; Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, 0603, La Jolla, CA, 92037, USA.
| | - Niloofar Afari
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, 116, San Diego, CA, 92161, USA; Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, 0603, La Jolla, CA, 92037, USA; VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Drive, 116, San Diego, CA, 92161, USA
| | - Sonya B Norman
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, 116, San Diego, CA, 92161, USA; Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, 0603, La Jolla, CA, 92037, USA; VA Center of Excellence for Stress and Mental Health, 3350 La Jolla Village Drive, 116, San Diego, CA, 92161, USA; National Center for PTSD, White River Junction, VT, USA
| | - Monica Guma
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, 116, San Diego, CA, 92161, USA; Department of Medicine, School of Medicine, University of California, 9500 Gilman Drive, San Diego, CA, 92037, USA
| | - Robert H Pietrzak
- National Center for PTSD, VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510, USA; Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, 06510, USA
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8
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Adami G. Mining the pathogenesis of rheumatoid arthritis, the leading role of the environment. RMD Open 2022; 8:rmdopen-2022-002807. [PMID: 36597981 PMCID: PMC9748982 DOI: 10.1136/rmdopen-2022-002807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 11/27/2022] [Indexed: 12/15/2022] Open
Abstract
The environment plays a crucial role in the pathogenesis of various diseases, including rheumatic musculoskeletal diseases (RMDs). Chronic exposure to air pollution has been associated with a number of detrimental effects on the immune system, including direct activation of autoimmunity and autoantibodies production. Rheumatoid arthritis (RA) is a paradigmatic example of the link between environmental stimuli and development of autoimmunity. Recent evidence has confirmed such association and provided further indication of the strict relationship between the lungs and the synovial tissue. Hard rock mining and chronic exposure to airborne fine particulate matter have been associated with higher risk of developing RA. In addition, new evidence showed a peculiar association between acute exposure to toxic inhalants and risk of RA flare. In conclusion, the environment is the straw that breaks the camel's back, unfortunately the "straws" are rapidly accumulating, and their burden is projected to increase accordingly.
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Affiliation(s)
- Giovanni Adami
- Medicine, Rheumatology Unit, Universita degli Studi di Verona Scuola di Medicina e Chirurgia, Verona, Italy
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9
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Che WI, Lundberg IE, Holmqvist M. Environmental Risks for Inflammatory Myopathies. Rheum Dis Clin North Am 2022; 48:861-874. [PMID: 36333000 DOI: 10.1016/j.rdc.2022.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This is an up-to-date review on external environmental factors for adult-onset idiopathic inflammatory myopathies (IIMs). Environmental factors with suggestive evidence including ultraviolet radiation, smoking, infectious agents (viruses in particular), pollutants, medications (ie, statin) and vitamin D deficiency are discussed. We also discuss the potential implications of environmental factors in IIM development, identify current challenges, and provide insight into future investigations.
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Affiliation(s)
- Weng Ian Che
- Department of Medicine, Solna, Eugeniahemmet, T2, Karolinska Universitetssjukhuset, Solna, Stockholm 171 76, Sweden; Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Ingrid E Lundberg
- Rheumatology, Karolinska University Hospital, Anna Steckséns gata 30A, Stockholm 171 76, Sweden; Division of Rheumatology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; ME Gastro, Derm and Rheuma, Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden.
| | - Marie Holmqvist
- Department of Medicine, Solna, Eugeniahemmet, T2, Karolinska Universitetssjukhuset, Solna, Stockholm 171 76, Sweden; Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Rheumatology, Karolinska University Hospital, Anna Steckséns gata 30A, Stockholm 171 76, Sweden; Division of Rheumatology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
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10
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Liu JL, Woo JMP, Parks CG, Costenbader KH, Jacobsen S, Bernatsky S. Systemic Lupus Erythematosus Risk: The Role of Environmental Factors. Rheum Dis Clin North Am 2022; 48:827-843. [PMID: 36332998 DOI: 10.1016/j.rdc.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Systemic lupus erythematosus (SLE) is a complex, chronic autoimmune disease. The etiology of SLE is multifactorial and includes potential environmental triggers, which may occur sequentially (the "multi-hit" hypothesis). This review focuses on SLE risk potentially associated with environmental factors including infections, the microbiome, diet, respirable exposures (eg, crystalline silica, smoking, air pollution), organic pollutants, heavy metals, and ultraviolet radiation.
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Affiliation(s)
- Jia Li Liu
- McGill University, Montreal, Quebec, Canada
| | - Jennifer M P Woo
- Epidemiology Branch, Department of Health and Human Services, National Institutes of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, USA
| | - Christine G Parks
- Epidemiology Branch, Department of Health and Human Services, National Institutes of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, USA
| | - Karen H Costenbader
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Søren Jacobsen
- Copenhagen Lupus and Vasculitis Clinic, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Sasha Bernatsky
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
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11
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Cazes N, Briquet A. COPD Risk After Military Service: Let's Go Further Before Concluding. Chest 2022; 162:e287-e288. [PMID: 36344145 DOI: 10.1016/j.chest.2022.06.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 06/27/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Nicolas Cazes
- Service médical d'urgence, Bataillon de marins-pompiers de Marseille, Marseille, France.
| | - Anaïs Briquet
- Pulmonology Department, Laveran Army Teaching Hospital, Marseille, France
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12
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Luedders BA, Mikuls TR, Thiele GM, Poole JA, England BR. Inhalant and Additional Mucosal-Related Environmental Risks for Rheumatoid Arthritis. Rheum Dis Clin North Am 2022; 48:781-798. [PMID: 36332995 PMCID: PMC10120871 DOI: 10.1016/j.rdc.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Rheumatoid arthritis (RA) occurs as the result of a complex interplay of environmental factors in a genetically susceptible individual. There is considerable evidence that the lungs may serve as an initial site of tolerance loss in the generation of RA-related autoimmunity, and several environmental inhalant exposures and lung diseases have been associated with RA risk. There is additional evidence that immune and microbial dysregulation of other mucosal sites, including the oral and gastrointestinal mucosa, may contribute to the development of RA. Epidemiologic evidence linking mucosal exposures to various environmental insults as risk determinants in RA will be reviewed.
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Affiliation(s)
- Brent A Luedders
- Division of Rheumatology & Immunology, University of Nebraska Medical Center, 986270 Nebraska Medical Center, Omaha, NE 68198-6270, USA; VA Nebraska-Western Iowa Health Care System, 4101 Woolworth Avenue, Omaha, NE 68105, USA
| | - Ted R Mikuls
- Division of Rheumatology & Immunology, University of Nebraska Medical Center, 986270 Nebraska Medical Center, Omaha, NE 68198-6270, USA; VA Nebraska-Western Iowa Health Care System, 4101 Woolworth Avenue, Omaha, NE 68105, USA
| | - Geoffrey M Thiele
- Division of Rheumatology & Immunology, University of Nebraska Medical Center, 986270 Nebraska Medical Center, Omaha, NE 68198-6270, USA; VA Nebraska-Western Iowa Health Care System, 4101 Woolworth Avenue, Omaha, NE 68105, USA
| | - Jill A Poole
- Division of Allergy & Immunology, University of Nebraska Medical Center, 985990 Nebraska Medical Center, Omaha, NE 68198-5990, USA
| | - Bryant R England
- Division of Rheumatology & Immunology, University of Nebraska Medical Center, 986270 Nebraska Medical Center, Omaha, NE 68198-6270, USA; VA Nebraska-Western Iowa Health Care System, 4101 Woolworth Avenue, Omaha, NE 68105, USA.
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13
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Trupin L, Schmajuk G, Ying D, Yelin E, Blanc PD. Military Service and COPD Risk. Chest 2022; 162:792-795. [PMID: 35469853 DOI: 10.1016/j.chest.2022.04.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 02/03/2023] Open
Affiliation(s)
- Laura Trupin
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, CA
| | - Gabriela Schmajuk
- San Francisco Veterans Affairs Health Care System, San Francisco, CA
| | | | - Edward Yelin
- Division of Rheumatology, Department of Medicine, Russell/Engleman Rheumatology Research Center, and Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA
| | - Paul D Blanc
- San Francisco Veterans Affairs Health Care System, San Francisco, CA; Division of Occupational and Environmental Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA.
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14
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Occupational Exposures in Rheumatoid Arthritis-related Airway Disease: A Missing Link? Ann Am Thorac Soc 2022; 19:1076-1077. [PMID: 35254944 PMCID: PMC9169125 DOI: 10.1513/annalsats.202201-079le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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15
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Woo JMP, Parks CG, Jacobsen S, Costenbader KH, Bernatsky S. The role of environmental exposures and gene-environment interactions in the etiology of systemic lupus erythematous. J Intern Med 2022; 291:755-778. [PMID: 35143075 DOI: 10.1111/joim.13448] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Systemic lupus erythematosus (SLE) is a complex, chronic autoimmune disease, whose etiology includes both genetic and environmental factors. Individual genetic risk factors likely only account for about one-third of observed heritability among individuals with a family history of SLE. A large portion of the remaining risk may be attributable to environmental exposures and gene-environment interactions. This review focuses on SLE risk associated with environmental factors, ranging from chemical and physical environmental exposures to lifestyle behaviors, with the weight of evidence supporting positive associations between SLE and occupational exposure to crystalline silica, current smoking, and exogenous estrogens (e.g., oral contraceptives and postmenopausal hormones). Other risk factors may include lifestyle behaviors (e.g., dietary intake and sleep) and other exposures (e.g., ultraviolet [UV] radiation, air pollution, solvents, pesticides, vaccines and medications, and infections). Alcohol use may be associated with decreased SLE risk. We also describe the more limited body of knowledge on gene-environment interactions and SLE risk, including IL-10, ESR1, IL-33, ITGAM, and NAT2 and observed interactions with smoking, UV exposure, and alcohol. Understanding genetic and environmental risk factors for SLE, and how they may interact, can help to elucidate SLE pathogenesis and its clinical heterogeneity. Ultimately, this knowledge may facilitate the development of preventive interventions that address modifiable risk factors in susceptible individuals and vulnerable populations.
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Affiliation(s)
- Jennifer M P Woo
- Epidemiology Branch, National Institutes of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, USA
| | - Christine G Parks
- Epidemiology Branch, National Institutes of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, USA
| | - Søren Jacobsen
- Copenhagen Lupus and Vasculitis Clinic, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Karen H Costenbader
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sasha Bernatsky
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
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16
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Schmajuk G, Trupin L, Yelin EH, Blanc PD. Dusty trades and associated rheumatoid arthritis in a population-based study in the coal mining counties of Appalachia. Occup Environ Med 2022; 79:308-314. [PMID: 34987082 DOI: 10.1136/oemed-2021-107899] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 12/01/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We previously showed increased coal mining-associated risk of rheumatoid arthritis (RA). Using additional survey data, we sought to delineate this risk further. METHODS We used data from two cross-sectional, random-digit-dial, population-based surveys (males;≥50 years) in selected counties in the Appalachian region of the inland, mid-Atlantic USA with elevated pneumoconiosis mortality. Surveys ascertained age, smoking, coal mining and non-coal silica exposure jobs. In a subset, we surveyed ergonomic exposures, scored by intensity. We queried diagnosis of RA, corticosteroid use, and, in a subset, use of disease modifying antirheumatic drugs (DMARDs). Multivariable logistic regression modelled RA risk (defined by glucocorticoid or DMARDs use) associated with coal mining employment, other silica exposure, smoking status, and age and ergonomic exposures. RESULTS We analysed data for 2981 survey respondents (mean age 66.6 years; 15% current, 44% ex-smokers). The prevalence of glucocorticoid-treated and DMARD-treated RA was 11% and 4%, respectively. Glucocorticoid-treated RA was associated with coal mining (OR 3.5; 95% CI 2.5 to 4.9) and non-coal mining silica exposure (OR 3.2; 95% CI 2.4 to 4.4). For DMARD-treated RA, the odds associated with coal mining and other silica remained elevated: OR 2.3 (95% CI 1.18, 4.5) and OR 2.7 (95% CI 1.51, 5.0), respectively. In the same model, the highest intensity ergonomic exposure also was associated with increased odds of RA (OR 4.3; 95% CI 1.96 to 9.6). CONCLUSIONS We observed a strong association between coal mining and other silica-exposing dusty trades and RA. Clinicians and insurers should consider occupational histories in the aetiology of RA.
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Affiliation(s)
- Gabriela Schmajuk
- Medicine, Veterans Health Administration, San Francisco, California, USA.,Medicine, University of California San Francisco, San Francisco, California, USA
| | - Laura Trupin
- Medicine, University of California San Francisco, San Francisco, California, USA
| | - Edward H Yelin
- Medicine, University of California San Francisco, San Francisco, California, USA
| | - Paul D Blanc
- Medicine, Veterans Health Administration, San Francisco, California, USA .,Medicine, University of California San Francisco, San Francisco, California, USA
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