When people with rheumatoid arthritis (RA) have a flare up even holding a cup of tea, going up and down stairs or getting dressed can seem like too much effort. While stress, infections and lifestyle habits are already known to influence symptoms a new research indicates that there’s another factor in symptoms that you may not have thought of i.e the air we breathe.
According to a study published in Annals of the Rheumatic Diseases (ARD) air pollution particularly fine particulate matter (PM2.5) could be a significant driver of disease activity and painful rheumatoid arthritis flare ups. RA is a long term autoimmune disorder where the immune system attacks the healthy parts of the joint resulting in swelling, pain, stiffness and inflammation. This medical condition affects almost 0.5 per cent to 1 per cent of the world’s adult population causing joint damage and organ toxicity when uncontrolled.
The researchers reported that although genetics have a large influence on the disease environmental factors are now becoming recognised as a significant factor in the development and progression of RA. For a long time smoking has been seen as a big risk factor but now the evidence is building up that polluted air is another factor.
Association between PM2.5 and RA flares
The prospective cohort study involved 1,070 patients with rheumatoid arthritis who were being treated at a large medical center in South Korea. The researchers analyzed 12,583 outpatient visits during 2021 to 2024 under real-world clinical practice.
The team looked at exposure to six common air pollutants including sulphur dioxide (SO2), nitrogen dioxide (NO2), ozone (O3), carbon monoxide (CO), PM10 and PM2.5 and compared this to patients’ disease activity and flare episodes during the course of a month. Several factors were also taken into account such as age, sex, medications, socioeconomic status and blood markers associated with RA among others. The results revealed PM2.5 was most closely linked to increased RA activity.
Why PM2.5 is harmful
PM2.5 are very small particles emitted by vehicle exhaust, industrial pollution, dust, soot and smoke. These tiny particles are smaller than red blood cells which can penetrate deep into the lungs and bloodstream. The researchers believe that these particles could lead to an overproduction of molecules known as reactive oxygen species which they say could be responsible for causing oxidative stress, damaging DNA and triggering inflammation throughout the body. This inflammatory reaction can lead to an increase in pain, swelling and frequency of RA attacks.
“This is one of the largest studies to use robust methods to link air pollutants with RA disease activity. Considering rising levels of air pollutants, these results have significant clinical, biologic, and public health implications,” wrote Dr. Jeffrey A. Sparks, Division of Rheumatology, Mass General Brigham/Brigham and Women’s Hospital and Harvard Medical School in an accompanying editorial.
“They also further reinforce that inhalants may have broad implications for risk and progression of RA and perhaps other autoimmune diseases. From a clinical perspective, this may offer avenues to lower the risk of RA flares by avoiding air with poor quality and provide some potential explanation for otherwise idiosyncratic RA flares.”
The authors noted a need for further research to clarify if the improvement in air quality could directly lower RA disease activity. This research cautions that air pollution is not just bad for the lungs but it can also aggravate autoimmune diseases such as rheumatoid arthritis although further research is needed on the matter. Keeping track of air quality, avoiding outdoor activities on days with high pollution levels and adhering to a treatment program can help patients better control their painful flare ups.
Disclaimer: This content is for informational purposes only and not medical advice. Consult a qualified healthcare professional for diagnosis, treatment or personalized rheumatoid arthritis care.
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