The researchers also used the polygenic risk score to assess the combined effect of genetic risk and air pollutants. We know SLE has a genetic background, given a concordance rate of 30–50% in monozygotic twins and substantial familial aggregation among patients with SLE.8,9 Genome-wide association studies (GWAS) have demonstrated over 60 risk loci for SLE vulnerability.8 The polygenic risk score assesses the cumulative effects of these multiple genetic risk variants. The higher the polygenic risk score, the higher the genetic risk of developing SLE one day.
Xing et al. found that participants with high genetic risk and high air pollution exposure had the highest risk of incident SLE, with adjusted hazard ratios ranging from 4.16 to 5.61. Simply put, high genetic risk and high air pollution exposure were found to be a double whammy.
Interview with the Investigators
Dr. Tian
Jian Yang, PhD, Department of Cardiology, The First College of Clinical Medical Science, China Three Gorges University & Yichang Central People’s Hospital, Yichang, China, and Yaohua Tian, PhD, Huazhong University of Science and Technology, Wuhan, China, offered insight on their fascinating research.
The Rheumatologist (TR): What should practicing rheumatologists take away from your findings?
Drs. Yang & Tian: Rheumatologists should be aware of the potential impacts of environmental factors, such as air pollution, on the development of SLE. This knowledge can help in understanding the multi-factorial nature of the disease and guiding patient assessments.
During patient evaluations, rheumatologists should inquire about environmental exposures, including air quality and potential pollutants. This approach could involve questions about where patients live and their occupational exposure and lifestyle factors—thus, guiding rheumatologists in preventive strategies for individuals with known risk factors.
Further, rheumatologists can contribute to the broader understanding of how such environmental factors may influence disease incidence and progression.
TR: Patients can’t change their genes (yet), and they may not be able to change where they live. With these factors in mind, what should patients do with this information?
Drs. Yang & Tian: Our current study provided novel evidence that air pollution not only contributes to cardiovascular and respiratory diseases, but also autoimmune diseases. Our current study could be used for health education and to remind people to pay attention to the adverse effects of air pollution on incident SLE, especially for people with genetic susceptibility. People may wear masks or reduce outings during poor air quality days.
