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Article

Influence of Ambient Air Pollution on Rheumatoid Arthritis Disease Activity Score Index

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Department of Mathematics and Statistics, University of Strathclyde, Glasgow G1 1XH, UK
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Department of Rheumatology, Al-Amiri Hospital, P.O. Box 4077, Safat 13041, Kuwait
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Department of Earth and Environmental Sciences, Kuwait University, P.O. Box 25944, Safat 1320, Kuwait
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Department of Agrometerology, Govind Ballabh Pant University of Agriculture & Technology, Pantnagar, Uttarakhand 263145, India
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Authors to whom correspondence should be addressed.
Kuwait Registry for Rheumatic Diseases (KRRD) Group Members: Khulood Saleh, Adel Al-Awadhi, Adeeba Al-Herz, Waleed Al-Kandari, Eman Hasan, Aqeel Ghanem, Mohammed Hussain, Yaser Ali, Ebrahim Nahar, Ahmad Alenizi, Sawsan Hayat, Fatemah Abutiban, Ali Aldei, Hebah Alhajeri, Ali Al-Sughayer, Naser Alhadhood, Khaled Mokaddam, Ahmad Khadrawy, Youssef Bartella.
Int. J. Environ. Res. Public Health 2020, 17(2), 416; https://doi.org/10.3390/ijerph17020416
Received: 19 October 2019 / Revised: 30 December 2019 / Accepted: 3 January 2020 / Published: 8 January 2020
(This article belongs to the Section Environmental Health)
Rheumatoid arthritis (RA) is a chronic autoimmune of an unknown etiology. Air pollution has been proposed as one of the possible risk factors associated with disease activity, although has not been extensively studied. In this study, we measured the relationship between exposure to air pollutants and RA activity. Data on RA patients were extracted from the Kuwait Registry for Rheumatic Diseases (KRRD). Disease activity was measured using disease activity score with 28 examined joints (DAS-28) and the Clinical Disease Activity Index (CDAI) during their hospital visits from 2013 to 2017. Air pollution was assessed using air pollution components (PM 10 , NO 2 , SO 2 , O 3 , and CO). Air pollution data were obtained from Kuwait Environmental Public Authority (K-EPA) from six different air quality-monitoring stations during the same period. Multiple imputations by the chained equations (MICE) algorithm were applied to estimate missing air pollution data. Patients data were linked with air pollution data according to date and patient governorate address. Descriptive statistics, correlation analysis, and linear regression techniques were employed using STATA software. In total, 1651 RA patients with 9875 follow-up visits were studied. We detected an increased risk of RA using DAS-28 in participants exposed to SO 2 and NO 2 with β = 0 . 003 (95% CI: 0.0004–0.005, p < 0 . 01 ) and β = 0 . 003 (95% CI: 0.002–0.005, p < 0 . 01 ), respectively, but not to PM 10 , O 3 , and CO concentrations. Conclusively, we observed a strong association between air pollution with RA disease activity. This study suggests air pollution as a risk factor for RA and recommends further measures to be taken by the authorities to control this health problem. View Full-Text
Keywords: air pollution; rheumatoid arthritis; DAS-28; CDAI; RA registry; KRRD; Kuwait; Middle East; AQI air pollution; rheumatoid arthritis; DAS-28; CDAI; RA registry; KRRD; Kuwait; Middle East; AQI
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MDPI and ACS Style

Alsaber, A.; Pan, J.; Al-Herz, A.; Alkandary, D.S.; Al-Hurban, A.; Setiya, P.; on behalf of the KRRD Group. Influence of Ambient Air Pollution on Rheumatoid Arthritis Disease Activity Score Index. Int. J. Environ. Res. Public Health 2020, 17, 416. https://doi.org/10.3390/ijerph17020416

AMA Style

Alsaber A, Pan J, Al-Herz A, Alkandary DS, Al-Hurban A, Setiya P, on behalf of the KRRD Group. Influence of Ambient Air Pollution on Rheumatoid Arthritis Disease Activity Score Index. International Journal of Environmental Research and Public Health. 2020; 17(2):416. https://doi.org/10.3390/ijerph17020416

Chicago/Turabian Style

Alsaber, Ahmad, Jiazhu Pan, Adeeba Al-Herz, Dhary S. Alkandary, Adeeba Al-Hurban, Parul Setiya, and on behalf of the KRRD Group. 2020. "Influence of Ambient Air Pollution on Rheumatoid Arthritis Disease Activity Score Index" International Journal of Environmental Research and Public Health 17, no. 2: 416. https://doi.org/10.3390/ijerph17020416

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