Rheumatological diseases, smog underestimated risk factor

A greater proportion of rheumatology patients live in the most polluted areas, who have a greater probability of having a relapse or having to change therapy because it no longer works. In fact, air pollution plays an important role in the onset, severity, reactivation and lack of response to therapies of some rheumatological diseases, rheumatoid arthritis first, and should in all respects be considered a risk factor to be mitigated. The alarm comes from the Italian Foundation for Research in Rheumatology (Fira) on the basis of studies and research carried out in recent years, in Italy and abroad.

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The results of the investigations conducted by the Rheumatology Complex Hospital Unit of the Integrated University Hospital of Verona, for example, show a correlation between the prevalence data of rheumatological diseases and the levels of fine particles: in the most polluted areas, that is, there are more diagnoses. “The investigation also found a greater risk of disease severity and reactivations of rheumatoid arthritis during the periods most polluted by carbon or nitrogen oxides or ozone or fine particles – he explains Maurizio RossiniProfessor of Rheumatology at the University of Verona and member of the Scientific Committee of Fira – Furthermore, it has been demonstrated that acute exposure to high levels of air pollution is a potential cause of ineffectiveness or loss of effectiveness of therapies, therefore determining the need of changes in therapy and an increase in costs for the National Health Service”.

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Also harmful to the bones

Exposure to fine dust (PM10 or PM2.5 and even finer dust) would also appear to have a negative effect on skeletal metabolism, acting on two fronts. On the one hand it seems capable of increasing the concentration of the RANKL protein – involved in the regulation and control of bone metabolism – and of promoting the release of inflammatory cytokines, which lead to the activation of osteoclasts, the cells that break down the bone making it stronger. fragile. On the other hand, the presence of a high concentration of particulate matter in the atmosphere reduces exposure to UVB solar rays, which is followed by a decrease in the body’s ability to produce vitamin D. A combination that produces a measurable effect. “In a study involving over 59,000 women distributed throughout Italy, we documented that exposure to high concentrations of fine particles smaller than 10 thousandths of a millimeter (PM 10) or 2.5 µm (PM 2.5) leads to an increased risk of osteoporosis of approximately 15%, particularly in the femur. This would help to justify the increased risk of femur fractures observed in periods of greater concentration,” says Rossini.

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Patients who are difficult to treat

Pollution together with socio-economic factors could therefore explain why, although the results obtained in the treatment of rheumatoid arthritis in the last two decades are considered by experts to be nothing short of sensational, there is still a non-negligible share of patients, calculable around 15 %, proves refractory to treatments. “The attention of the research is therefore focusing on this population, trying to clarify the reasons for these difficulties – he explains Carlomaurizio MontecuccoPresident of FIRA and professor of Rheumatology at the University of Pavia at the San Matteo Polyclinic – Among the most important factors in identifying the ‘difficult to treat’ population are obesity and smoking, risk factors for the development of arthritis, and low socioeconomic level.”

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Alongside patients who do not respond to drugs, there are also those who, although achieving improvements in terms of inflammation and joint deformity, continue to suffer from pain, tiredness and a profound subjective sense of malaise. “It seems likely that it is a residual inflammation limited to the nervous system and not directly diagnosable with the usual indicators used in arthritis. The effectiveness of some arthritis drugs that cross the blood-brain barrier, and are therefore able to act on neuroinflammation, seems to provide evidence to support this possibility and open new avenues of treatment for these patients too” , adds Montecucco.

And give

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Advice for patients

In short, new generation drugs have certainly achieved a good level of effectiveness, but scientific research demonstrates that there are a plurality of factors to consider and related mechanisms to investigate to ensure a better state of health and well-being for patients. Among these also smog, which however cannot always be avoided. So what to do? “For fragile and immunosuppressed people, for patients or those who are particularly at risk, the advice is to check the fine dust bulletin, now available in many apps, and in case of high levels, consider not leaving the house or at least wear an FFP2 mask”, concludes Rossini.