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

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  • Ahmad Alsaber

    (Department of Mathematics and Statistics, University of Strathclyde, Glasgow G1 1XH, UK)

  • Jiazhu Pan

    (Department of Mathematics and Statistics, University of Strathclyde, Glasgow G1 1XH, UK)

  • Adeeba Al-Herz

    (Department of Rheumatology, Al-Amiri Hospital, P.O. Box 4077, Safat 13041, Kuwait)

  • Dhary S. Alkandary

    (Department of Earth and Environmental Sciences, Kuwait University, P.O. Box 25944, Safat 1320, Kuwait)

  • Adeeba Al-Hurban

    (Department of Earth and Environmental Sciences, Kuwait University, P.O. Box 25944, Safat 1320, Kuwait)

  • Parul Setiya

    (Department of Agrometerology, Govind Ballabh Pant University of Agriculture & Technology, Pantnagar, Uttarakhand 263145, India)

  • on behalf of the KRRD Group

    (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.)

Abstract

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.

Suggested Citation

  • Ahmad Alsaber & Jiazhu Pan & Adeeba Al-Herz & Dhary S. Alkandary & Adeeba Al-Hurban & Parul Setiya & on behalf of the KRRD Group, 2020. "Influence of Ambient Air Pollution on Rheumatoid Arthritis Disease Activity Score Index," IJERPH, MDPI, vol. 17(2), pages 1-17, January.
    • Handle: RePEc:gam:jijerp:v:17:y:2020:i:2:p:416-:d:306406
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    References listed on IDEAS

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    1. Junhyeong Lee & Wanhyung Lee & Won-Jun Choi & Seong-Kyu Kang & Seunghon Ham, 2019. "Association between Exposure to Extreme Temperature and Injury at the Workplace," IJERPH, MDPI, vol. 16(24), pages 1-10, December.
    2. Wickham, Hadley, 2011. "The Split-Apply-Combine Strategy for Data Analysis," Journal of Statistical Software, Foundation for Open Access Statistics, vol. 40(i01).
    3. Jiyoung Shin & Jiyoung Lee & Jueun Lee & Eun-Hee Ha, 2019. "Association between Exposure to Ambient Air Pollution and Rheumatoid Arthritis in Adults," IJERPH, MDPI, vol. 16(7), pages 1-10, April.
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    1. Ahmad R. Alsaber & Jiazhu Pan & Adeeba Al-Hurban, 2021. "Handling Complex Missing Data Using Random Forest Approach for an Air Quality Monitoring Dataset: A Case Study of Kuwait Environmental Data (2012 to 2018)," IJERPH, MDPI, vol. 18(3), pages 1-25, February.

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