Background/Purpose: Air pollution may contribute to many autoimmune diseases including systemic lupus erythematosus (SLE), but limited information is available on its role in the onset and progression of SLE. The objective of the current study was to determine the relationship between air pollution exposure and characteristics associated with expression and severity of SLE.

Methods: In this retrospective cohort study, we identified patients with childhood onset SLE (cSLE) residing in the greater Cincinnati, OH region at the time of their SLE diagnosis and being followed for their care at Cincinnati Children’s Hospital Medical Center (CCHMC). Demographic and clinical information at the time of diagnosis were extracted from our cSLE cohort, and included phenotypic information on SLE (1997 American College of Rheumatology classification criteria) and SLE disease activity index (SLEDAI). Patients’ home address at the time of diagnosis was geocoded. Exposure to traffic-related pollutants was estimated for each participant by calculating the distance to the nearest major road. In addition, a previously developed and validated land-use regression model for the study region was applied to estimate the concentrations of elemental carbon attributable to traffic (ECAT), a surrogate marker for traffic related air pollution and specifically attributable to diesel exhaust. SLEDAI scores were categorized as high (> 8) or low to moderate activity (≤8). ECAT concentrations were log transformed and logistic regression was used to estimate the association between air pollution exposures and SLEDAI (high/low) and ACR classification criteria for phenotypic expression of disease.

Results: The cSLE patients’ (n = 158) mean age at diagnosis was 16.9 (SD 4.2) years. The majority (76.7%) were female with nearly equal representation of Caucasians and African Americans (42.1% and 41.5%, respectively). ECAT exposures were not associated with overall disease activity (SLEDAI) (Odds Ratio (OR) 1.4 (95% CI 0.3 – 7.1). However, as shown in Table 1with higher ECAT exposures there was a significantly increased risk for renal involvement (OR = 3 (95% CI 1.0- 8.7)) also a trend towards experience more commonly serositis (OR = 3.8 (95% CI 0.8 – 18.2)).

Conclusion: Our preliminary study suggests that environmental exposure to air pollution is associated with increased risk for certain manifestations of cSLE. Further work is needed to establish longitudinal effect of air pollution on the disease activity and cumulative damage and cSLE phenotypes over time.

TABLE 1: Logistic Regression Analysis of log (ECAT) values versus presence of phenotypic features of cSLE at disease onset

ECAT = elemental carbon attributable to traffic; ACR = American College of Rheumatology; ANA = Antinuclear antibody

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/exposure-to-air-pollution-and-the-onset-and-progression-of-systemic-lupus-erythematosus/