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BackgroundRecently, we showed that exposure to outdoors pollutants was associated with an increase of hospitalizations in paediatric rheumatic diseases (1) and higher risk of disease activity in our childhood-onset systemic lupus erythematous (cSLE) patients (2).Exhaled breath biomarkers measurements, such as exhaled breath condensate (EBC) and fractional concentration of exhaled nitric oxide (FeNO) may indicate airways inflammation related to air pollutant exposure. To our knowledge, this was the first study that showed the effects of daily exposure to PM2.5, assessed by personal real time monitoring, on airway inflammation and increased risk of disease activity in cSLE patients.ObjectivesTo investigate the association between daily individual real-time exposure to air pollutants and disease activity in cSLE patients.MethodsA longitudinal panel study was carried-out in 108 consecutive visits of cSLE patients. During four consecutive weeks, daily personal measures of nitrogen dioxide (NO2), fine particulate matter (PM2,5), ambient temperature and humidity were obtained.This cycle was repeated every 2.5 months along one year and pH of exhaled breath condensate (EBC pH), fractional exhaled NO (FeNO) and disease activity parameters were collected weekly. Specific generalized estimation equation models were used to assess the impact of these pollutants on the risk of moderate/severe disease activity (SLEDAI-2K≥8), EBC pH and FeNO considering the fixed effects for repetitive measurements. The models were adjusted for inflammatory indicator, body mass index, infection, medication and weather variables.ResultsFor an interquartile range increase of 18.12μg/m3 in PM2.5 daily concentration we observed an increased short-term effect in FeNO at the first three days (lag 0 to lag 2) after exposure. The 3-day moving average effect on FeNO was an increase of 0.75 ppb (95%IC: 0.38–1.29). Decreases in EBC pH were evidenced at days 7 and 10 after exposure [0.09 (95%IC: 0.15–0.02); 0.09 (95%IC: 0.17–0.01) respectively]. Regarding the risk of SLEDAI-2K ≥8, an increase of 18.12 μg/m3 in PM2.5 was associated with increases in the risk of SLEDAI-2K ≥8 at four [RR 1.45 (95%CI: 1.24–1.66)] and 11 days [RR 1.34 (95%CI: 1.05–1.62)] after exposure.ConclusionsReal-time exposure to air pollution may have a role in triggering disease activity and airways inflammation in cSLE patients.ReferencesVidotto JP, Pereira LAA, Braga ALF et al. Atmospheric pollution:influence on hospital admission in pediatric rheumatic disease. Lupus. 2012;21:526–33Fernandes EC, Silva CA, Braga ALF, Sallum AM, Campos LM, Farhat SC. Exposure to air pollutants increased disease activity in childhood-onset systemic lupus erythematosus patients. Arthritis Care Res. 2015; 67:1609–14.AcknowledgementSupported by Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP 13/21508–2), Conselho Nacional de Desenvolvimento Científico e Tecnolόgico (CNPQ 302724/2011–7 and 472155/2012–1), Federico Foundation and Núcleo de Apoio à Pesquisa “Saúde da Criança e do Adolescente” da USP...

Objective To assess the effect of individual exposure, in real-time, to traffic-related pollutants on serum interleukin levels of childhood-onset lupus erythematous systemic (c-SLE) patients. Methods A longitudinal and observational design was conducted in 12 repeated measures of serum samples and clinical evaluations (totaling 108 measurements) of c-SLE patients over 30 consecutive months. Real-time, individual exposure to fine particles (PM2.5) and nitrogen dioxide (NO2) was measured with portable monitors. Generalized estimating equation was used to evaluate the association between exposure to PM2.5 and NO2 and the following serum cytokine levels on the 7 days preceding clinical assessment and serum collection: MCP1, IL-6, IL-8, IL-10, IL-17, IFN-alpha, and TNF-alpha. Disease activity and other risk factors were also controlled. Results An interquartile range (IQR) increase in PM2.5 daily concentration was significantly associated with increased levels of TNF-alpha on the third, fourth, and seventh day after exposure; IL-10 on the third and fourth day after exposure; IL-17 on the third and seventh day after exposure; and INF-alpha on the third day after exposure ( p < 0.05). An IQR increase in 7-day moving average of PM2.5 was associated with a 6.2 pg/mL (95% CI: 0.5; 11.8; p = 0.04) increase in serum IFN-alpha level. An unexpected significant association was observed between an IQR increase in NO27-day cumulative concentration and a decrease of 1.6 pg/mL (95% CI: −2.6; −0.7; p < 0.001) in serum IL-17. Conclusion Real-time exposure to PM2.5 prospectively associated with increased serum TNF-alpha, INF-alpha, IL-10, and IL-17 levels in c-SLE patients.

Goulart MFG. Influence of air pollution on renal activity of juvenile systemic lupus erythematosus patients [thesis]. São Paulo: "Faculdade de Medicina, Universidade de São Paulo"; 2019.Childhood-systemic lupus erythematosus (cSLE) is an inflammatory chronic, autoimmune and multifactorial disease that can affect different organs and systems. Exposure to air pollution can trigger systemic inflammation in cSLE patients and increase the risk of disease activity. Objective: To evaluate the effect of individual exposure to air pollutants on renal activity by Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) in cSLE patients. Methodology: A longitudinal panel study was carried out in 108 consecutive medical appointments with nine cSLE patients. Over a period of three consecutive weeks, individual levels of nitrogen dioxide (NO2), fine particulate matter (PM2.5) as well as temperature and humidity were measured daily. Each three-week cycle was repeated every two months and half over a period of one year and clinical evaluation and laboratory tests for SLEDAI-2K evaluation were performed weekly. Specific generalized estimation equation models were used to assess the impact of these pollutants on the risk of disease activity (SLEDAI-2K≥8), nephritis and anti-dsDNA positive levels. We also evaluated continuous variables: 24-hour urine protein and serum complement (C3) levels. Models were adjusted for inflammatory indicators, body mass index, infections, medications and weather variables. Results: An interquartile range (IQR) increase of 18.12µg/m3 in PM2.5 daily concentration was associated with an increased risk of: nephritis, anti-dsDNA positive levels and SLEDAI-2K≥8. Moreover, an increase in 24-hour urine protein and a decrease in serum C3 levels were observed. An IQR increase in PM2.5 7-day moving average was associated with an increased risk of leukocyturia (3.4 95%IC:2.6-4.3), anti-dsDNA positive levels (3.1; 95%CI:2.1-4.0) and SLEDAI≥8 (1.5; 95%CI:1.1-1.8). In addition, a 36.3 mg increase (95%IC:20.2-52.3) in 24-hour urine protein levels as well as a 1,9 mg/ dl (95% IC -0,06: -3,8) decrease in C3 levels. An IQR increase (63.1µg/m3) in 7-day cumulative NO2 levels was associated with an increased risk of SLEDAI ≥ 8 (2.6; 95%CI: 1.9-3.3) and a 6.4 mg/ dl (IC95%: -10,9: -1,9) decrease in C3 levels. Conclusion: This prospective study suggests that exposure to air pollution can trigger renal activity in cSLE patients.