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Objectives Juvenile idiopathic arthritis (JIA) is the most common pediatric rheumatic disease, thought to be influenced by both genetics and the environment. Identifying environmental factors associated with disease risk will improve knowledge of disease mechanisms and ultimately benefit patients. This review aimed to collate and synthesize the current evidence of environmental factors associated with JIA. Methods MEDLINE (Ovid), EMBASE (Ovid), Cumulative Index of Nursing and Related Health Literature (EBSCOhost), science network (WOS, Clarivate Analytics), Chinese National Knowledge Infrastructure, and Chinese Biological Medical Database were systematically searched. Study quality was rated using the Newcastle‐Ottawa Scale. Pooled estimates for each environmental factor were generated using a random‐effects, inverse‐variance method, where possible. The remaining environmental factors were synthesized in narrative form. Results This review includes environmental factors from 23 studies (6 cohorts and 17 case‐control studies). Cesarean section delivery was associated with increased JIA risk (pooled relative risk [RR] 1.103, 95% CI 1.033‐1.177). Conversely, maternal smoking of more than 20 cigarettes/day (pooled RR 0.650, 95% CI 0.431‐0.981) and gestational smoking (pooled RR0.634, 95% CI 0.452‐0.890) were associated with decreased JIA risk. Conclusion This review identifies several environmental factors associated with JIA and demonstrates the huge breadth of environmental research. We also highlight the challenges of combining data collected over this period due to limited study comparability, evolution in healthcare and social practices, and changing environment, which warrant consideration when planning future studies.

Early-onset Systemic lupus erythematosus (SLE) is a heterogeneous disease with more variable symptoms than other types of SLE. It can begin as early as 12 months after birth, and the clinical process appears to be more severe. The common clinical manifestations of early-onset SLE are skin and mucosal lesions, renal involvement, central nervous system diseases and hematological system abnormalities. Although the disease is well described in the literature, diagnosis is often difficult due to its insidious onset, early onset, and atypical symptoms. Here, we present four cases of early-onset SLE. Next-generation sequencing were performed and detected mutations were confirmed by Sanger sequencing in all four cases. In addition, glucocorticoid, propyl, cyclophosphamide, and other drugs were significantly improved after treatment. Conclusion: To our knowledge, this is the first case study in China describing early-onset SLE. With the research progress and knowledge integration of basic disciplines such as genomics, epigenetics and immunology, the pathogenesis of early-onset SLE and other rheumatoid immune diseases will be revealed, which will bring more hope for the diagnosis and treatment of early-onset SLE.