Medical Journal of the Islamic Republic Of Iran

en Influence of Air Pollutants on the Disease Activity and Quality of Life in Rheumatoid Arthritis, an Iranian Observational Longitudinal Study Rheumatology Rheumatology Original Research Original Research     Background: Environmental exposures and genetic predisposition interactions may result in autoimmune rheumatic diseases. This study aimed to determine the effect of outdoor air pollutants on the activity of rheumatoid arthritis (RA) in a longitudinal follow-up.    Methods: We longitudinally studied 50 patients with RA bimonthly over 6 months in Mashhad, one of the most polluted cities in Iran. Disease activity and health-related quality of life (HRQoL) were examined according to the disease activity score (DAS28ESR), health assessment questionnaires (HAQ), physical health component summary (PCS), and visual analogue scale (VAS) criteria. The outdoor air pollutant was measured by monitoring the average concentration of nitrogen oxide (NO), carbon monoxide (CO), O2 level, Sulfur dioxide (SO2), and some particles less than 10 and 2.5 micrometers in diameter (PM <10 µm, PM <2.5 µm). The temperature and humidity levels were also measured. The univariate and multivariate statistical analyses were used for data analysis and the role of confounding factors was determined using the generalized estimation equation method.    Results: Statistical analysis indicated a significant increase of the DAS28ESR (B = 0.04 [0.08]; P = 0.01) and VAS (B = 4.48 [1.73]; P = 0.01) by CO concentration. Moreover, a number of polluted days increased the VAS in patients. In addition, other air pollutants, temperature, and humidity were not affected significantly by the DAS28ESR and quality of life indexes by considering confounders such as medications, age, and job.    Conclusion: Based on our findings, CO concentration was the only effective outdoor air pollutant that could increase RA disease activity. In addition, CO concentration and the number of polluted days make patients feel more ill. As the role of indoor air pollutants is highly important, further research on this critical topic is required to establish the role of air pollution on RA disease activity.   Rheumatoid Arthritis, Disease Activity, Carbon Monoxide, Air Pollution, Nitric Oxide, Temperature, Humidity, PM <10 µm, PM <2.5 µm 533 540 http://mjiri.iums.ac.ir/browse.php?a_code=A-10-7784-1&slc_lang=en&sid=1 Maryam Sahebari sahebarim@mums.ac.ir 200319475328460077914 200319475328460077914 No Rheumatic Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran Maryam Esmailpour esmailpoorm2@yahoo.com 200319475328460077915 200319475328460077915 No School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Habibollah Esmaili esmaillyh@mums.ac.ir 200319475328460077916 200319475328460077916 No Social Determinates of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran Arezoo Orooji arezoo.orooji23@gmail.com 200319475328460077917 200319475328460077917 No Social Determinates of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran Yousef Dowlatabadi drjoseph.medicine@gmail.com 200319475328460077918 200319475328460077918 No School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Shima Nabavi Mahali NabaviMSH@mums.ac.ir 200319475328460077919 200319475328460077919 No Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran Enayat Rajabi Enayat_Rajabi@cbu.ca 200319475328460077920 200319475328460077920 No Shannon School of Business, Cape Berton University, Sydney, NS, Canada Masoumeh Salari salarim@mums.ac.ir 200319475328460077921 200319475328460077921 Yes Rheumatic Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran