Panel Defines Environmental Threats in Rheumatic Disease

Toxic chemicals, air pollution, and many more harmful substances and practices pose environmental health hazards to people with rheumatic disease.

A panel of rheumatology experts discussed Environmental Threats in Rheumatic Disease in a Monday, Nov. 18, session at ACR Convergence. The session will be available on-demand to all registered ACR Convergence 2024 participants through Oct. 10, 2025, by logging into the meeting website.

The World Health Organization (WHO) and The Lancet have declared climate change the most significant threat to human global health in the 21st century, said Tamiko Katsumoto, MD, Clinical Associate Professor with the Division of Immunology and Rheumatology at Stanford University, who addressed why rheumatologists should be concerned about how the environment affects human health. Studies have shown a correlation between increased air pollution and increased disease activity and incidence of rheumatic disease.

Various pollutants also have affected disease incidence outside of rheumatology as well. As the number of chronic disease cases in the United States has soared over the past few decades, so has the use of chemicals. Often, the public has no idea what goes into the chemical process because manufacturers are not required by law to disclose all of the ingredients in their products, Dr. Katsumoto said.

“This is highly concerning and clearly a threat that we need to be worried about,” she said.

Pesticides and other persistent organic pollutants remain in the environment for decades and have been known to travel long distances, sometimes as far as the Arctic and Antarctic regions. Particularly disturbing from a health perspective is that many of these substances are endocrine-disrupting chemicals, Dr. Katsumoto said.

Environmental exposures are thought to play a role in about 80% of diseases, she explained. Research indicates that microplastics containing endocrine-disrupting chemicals have been found in human joints and potentially aggravate rheumatic disease and several chronic diseases.

Moreover, endocrine-disrupting chemicals are found in numerous products and have properties that have been shown to impair immune function, noted Dr. Katsumoto. Further research is needed to determine the potential role they play in driving autoimmunity, she said.

The negative impacts of air pollution are another major concern for people with autoimmune diseases, said Sasha Bernatsky, MD, PhD, Rheumatologist and Professor of Medicine at McGill University in Montreal, Canada. Pollution contains tiny particles known as particulate matter 2.5 (PM2.5) that are associated with increased risk and disease activity in rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). Nitrogen dioxide, another air pollutant, also is associated with SLE and RA disease and hospitalization, she said.

The WHO estimates that about 90% of the global population breathes air that exceeds guidelines for exposure limits to PM2.5, Dr. Bernatsky said, adding that developing a better understanding of the health effects of air pollution is needed to support efforts to bring better air quality to more people.

“Air pollution has consequences for everyone on the globe because, to some extent, we’re all affected by it,” Dr. Bernatsky said. 

Everyone has an individual responsibility to reduce greenhouse gas emissions and other threats linked to climate change, noted Paul Dellaripa, MD, Rheumatologist at the Division of Rheumatology at Brigham and Women’s Hospital and Associate Professor at Harvard Medical Center. Rheumatologists can answer the challenge in different aspects of their work life — as a clinician, educator, researcher, or advocate — and by examining sustainability hits and misses within their own practices, he said.

Dr. Dellaripa advised rheumatology clinicians to find a way to connect with patients on the topic of climate change and encourage healthy behaviors that also are healthy for the planet. That could mean using different words, like “weather” and “pollution,” to keep politics out of the conversation.

“You want to engage your patients without offending them or creating a barrier,” he said.

Dr. Dellaripa acknowledged that thoughts of climate change can be overwhelming.

“If you think about it in its enormity, you can become paralyzed,” he said. “We all have talents and skills and energy, and we have to apply them the best way we can, not just for other people, but for what we stand for as an individual — our own values.”