When trying to pinpoint the connection to climate because it may exacerbate rheumatic conditions, Dr. Dellaripa said that immune system changes and epigenetic effects may be caused by exposure to heat, wildfire and other climate effects.
“That’s where we don’t know enough yet. … That’s where the gap in our knowledge is at this point and [what] future investigations need to be focused [on],” he said.
Climate Research
Dr. Dellaripa shared some experiences that sparked his interest in climate change and how it relates to rheumatology. More than 10 years ago, he was caring for a hospital patient who had returned from Australia after being exposed to a wildfire there that exacerbated her asthma and forced her to leave. Upon her return to Boston, she was hospitalized due to severe respiratory distress.
He also saw patients presenting with interstitial lung disease (ILD) closely after exposure to a wildfire in California.
“I couldn’t conclude clear causation between their exposure and the development of their autoimmune ILD, but it did raise the question of whether smoke due to wildfires may have played a role in the development of their disease.” Another possibility: “Patients with pre-existing rheumatic diseases may worsen with such exposures,” he said.
Dr. Dellaripa brought his concerns and research on the topic to the ACR, which formed a study group. This led to the publication of a white paper on the effects of climate change on rheumatic conditions published earlier this year.4
After analyzing 88 articles, the study team behind the white paper found that increased heat vulnerability was associated with higher odds of recurrent hospitalizations across rheumatic conditions and that air pollution was associated with an increased risk of rheumatoid arthritis (RA), gout flares and hospitalizations for systemic lupus erythematosus. Although exact causes remain unknown, the study team suggested these findings could be related to epigenetic changes, oxidative stress and inflammatory cytokines.4
More research needs to be conducted, and other disciplines, such as allergy, cardiology pulmonary and nephrology, are further ahead of rheumatology in this type of research, Dr. Dellaripa noted. However, he believes the research will continue to move forward in rheumatology with the support of professional societies, patient support groups and federal efforts.
Future research should also include a focus on how climate change has affected those who are traditionally marginalized, Dr. Hausmann says.
Dr. Dellaripa pointed to heat exposure research he was involved with that showed a significant overlap between those areas with the highest level of heat and social vulnerability.5
