Ultraviolet Radiation Exposures Are Associated with Dermatomyositis in a National Myositis Registry

Christine G. Parks¹, Jesse Wilkerson², Kathryn M. Rose², Abdullah Faiq³, Payam Noroozi Farhadi³, Craig S. Long⁴, Nastaran Bayat³, Hermine I. Brunner⁵, Bob Goldberg⁶, John McGrath², Frederick W. Miller³ and Lisa G. Rider³, ¹Epidemiology Branch, National Institute of Environmental Health Sciences, NIH, Durham, NC, ²Social and Scientific Systems, Inc., Durham, NC, ³Environmental Autoimmunity Group, National Institute of Environmental Health Sciences, NIH, Bethesda, MD, ⁴NOAA/National Weather Service, National Centers for Environmental Prediction Climate Prediction Center, College Park, MD, ⁵Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, ⁶The Myositis Association, Alexandria, VA

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: dermatomyositis, environmental factors and myositis

Session Information

Date: Monday, November 14, 2016

Title: Epidemiology and Public Health - Poster II

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: Previous studies suggest exposure to ultraviolet (UV) radiation may be a risk factor for dermatomyositis (DM) and autoantibody phenotypes, based on differences in prevalence associated residential environmental UV levels in proximity to diagnosis. However, the role of individual determinants of exposure and susceptibility is unknown.

Methods: We analyzed data from adult patients (ages 18-65) in a national myositis patient registry (including 658 dermatomyositis [DM], 451 polymyositis [PM], and 309 inclusion body myositis [IBM]) diagnosed through 2011. A questionnaire collected data on geographic residence, sun sensitivity (tendency to experience severe or painful sunburns), history of sunburn in the 12 months prior to diagnosis, and history of specific jobs, longest job and hobbies (specified as outdoor and other) prior to diagnosis. Using a job-exposure matrix and consensus review blinded to myositis subgroup, jobs and hobbies were rated for sun exposure intensity (high, moderate, low, or none), with a certainty level assigned to each estimate (high or low). Maximum residential UV exposures were identified for the 12 months prior to diagnosis for cases diagnosed after 1990, using data on UV-B Erythemal irradiances from the NASA Total Ozone Mapping Spectrometer (TOMS). Comparing DM with PM and IBM patients, odds ratios (OR) and 95% confidence intervals (CI) were estimated for sunburn and UV exposures in the year prior to diagnosis using logistic regression models adjusted for age, skin tone, and sex. Stratified models explored the potential modifying role of maximum residential UV levels and sun sensitivity on recreational/occupational exposures.

Results: Sunburn in the year prior to diagnosis was reported by 41% of DM compared with 28% of PM/IBM patients (OR=1.55: 95%CI 1.22, 1.96). DM was associated with high or moderate sun exposures from outdoor recreation or hobbies in the year prior to diagnosis (OR=1.38: 95%CI 1.08, 1.76, vs. PM/IBM), and together, high or moderate recreational or occupational sun exposure was associated with DM vs. PM/IBM (high OR=1.61: 95%CI 1.08, 2.42; moderate OR=1.37: 95%CI 1.05, 1.79). The association of DM with moderate recreational/occupational exposures was most apparent in patients with higher environmental UV levels (OR=1.56: 95%CI 1.06, 2.30) and those who reported being less likely to have severe sunburns (OR=1.62: 95%CI 1.16, 2.26). Sensitivity analyses showed the associations with occupational or recreational exposures remained after excluding patients reporting any sunburn in the year prior to diagnosis, and in analyses limited to high certainty exposure estimates.

Conclusion: These findings suggest that sunburn and high intensity sun exposures from recreational or occupational activities within a year prior to diagnosis may be associated with greater risk of developing DM compared to other myositis subtypes. Results support investigation of the role of sun exposures in relation to environmental UV, individual susceptibility and protective behaviors, in the risk of DM.

Disclosure: C. G. Parks, None; J. Wilkerson, None; K. M. Rose, None; A. Faiq, None; P. Noroozi Farhadi, None; C. S. Long, None; N. Bayat, None; H. I. Brunner, The Myositis Association, 2; B. Goldberg, Centers for Disease Control, 2; J. McGrath, None; F. W. Miller, None; L. G. Rider, None.

To cite this abstract in AMA style:

Parks CG, Wilkerson J, Rose KM, Faiq A, Noroozi Farhadi P, Long CS, Bayat N, Brunner HI, Goldberg B, McGrath J, Miller FW, Rider LG. Ultraviolet Radiation Exposures Are Associated with Dermatomyositis in a National Myositis Registry [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/ultraviolet-radiation-exposures-are-associated-with-dermatomyositis-in-a-national-myositis-registry/. Accessed .

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