SLE, the most common type of lupus, can affect the whole body. Symptoms can include rash, arthritis, fever, fatigue, headaches, and sun sensitivity. SLE severity can differ widely from patient to patient. The study found associations between atmospheric and environmental changes 10 days before patients visited a clinic seeking treatment for lupus symptoms and the specific organ those symptoms seemed to affect. The hope is that this research and further work on the questions these findings point to may one day lead to improved methods of predicting lupus flares and treating them, says lead investigator George Stojan, MD, an assistant professor of medicine in the division of rheumatology at the Johns Hopkins Medical School in Baltimore, and the codirector of the Hopkins Lupus Center. “My ultimate goal is to create a model using climate and atmospheric factors that can predict when certain flares might occur, and then prevent them,” he says. Previous research has shown significant seasonal variation in lupus disease activity, such as renal flares being more common in the winter months and increased arthritis symptoms occurring in the spring and summer months; but this is the first study that looked at the link between organ-specific lupus flares and atmospheric changes prior to patient visits, says Dr. Stojan. RELATED: 5 Things Selena Gomez’s Battle With Lupus Have Taught Us About the Autoimmune Disease
Factors Like Temperature, Wind, and Humidity Linked to Lupus Flares
For the new study the researchers looked at data from 1,628 patients with lupus who were treated for flares at Johns Hopkins between 1999 and 2017. Then, using data from the Environmental Protection Agency (EPA), the researchers looked at atmospheric conditions, such as measures of ozone concentration, temperature, residual wind, relative humidity, and barometric pressure, 10 days before the patients’ doctor visits. The researchers adjusted for factors like age, sex, income, ethnicity, residence in rural versus urban areas, and how close patients lived to areas with higher pollution levels, such as living near highways and airports. They found specific and strong associations between atmospheric variables and organ-specific lupus flares, says Stojan. The data showed:
Increase in temperature was associated with joint complaints, rashes, and serositis (inflammation of the membrane around the lungs or heart).Higher temperature and ozone concentration was associated with a decrease in renal flares (inflammation of the kidney).Increase in humidity was associated with joint issues and serositis.Residual wind was associated with joint, neurologic, hematologic, and pulmonary problems.Higher particulate matter concentration was associated with pulmonary issues and serositis.
While the study shows that there is a strong association between changes in atmospheric and environmental conditions 10 days prior to patient visit and organ-specific lupus symptoms during the medical visit, Stojan points out that no single environmental or atmospheric variable was shown to be linked to all lupus flares. That means, while these aforementioned weather variables appear to be associated with these types of lupus flares, the data does not necessarily indicate that lupus flares are weather-related. RELATED: Common Signs and Symptoms of Lupus It’s also important to note that the findings are correlational, not causational. The data shows that there is a clear relationship between weather conditions and lupus flare-ups, but it does not show necessarily what that relationship is. Another limitation of the work is that the researchers did not control for other potential lupus triggers (like smoking and viral infections) or disease severity, which might also contribute to how weather affects lupus flares. Follow-up research that controlled for these other potential triggers and factors would reveal more about the relationship between weather changes and lupus symptom flares, says Shivani Garg, MD, assistant professor and the director of the Lupus and Nephritis Clinic at the University of Wisconsin School of Medicine and Public Health in Madison. Stojan notes that follow-up studies should also be done to include more environmental factors. It will also be important to follow individuals with lupus prospectively rather than look at retrospective data, he adds. For instance, having individuals use wearable personal monitors to measure atmospheric variables like pollution and wind would help researchers be able to determine the time frame in which exposure to certain factors might make flares more likely. For this study, another limitation was that the researchers looked at a time frame of just 10 days prior to the medical appointment during which they had lupus symptoms, Stojan says.
How These Findings May Affect Living With Lupus and Lupus Treatment
This research is a first step, but further studying these questions might help doctors one day be able to help patients predict lupus flare-ups that are in one way or another related to weather and atmospheric events, Stojan says. By using what they know about climate and atmospheric factors, such as pollution in a certain region, and how they change over time, scientists may one day even be able to devise models to predict when certain flares might occur and help prevent them, says Stojan. And, notes Stojan, these findings raise the possibility that previous lupus trials may have been affected by previously unrecognized environmental factors. For instance, it may be the case that weather events have played a more significant effect than previously realized in unsuccessful trials of certain drugs for lupus, Stojan says. “Maybe we’re not taking into account factors like the fact that symptoms flare in winter and that the medication was working all along.” This study also adds another valuable aspect to the management of lupus flares by validating the many patients who claim their disease is influenced by weather changes and who inspired this research, says Stojan. “We always hear from patients that changes in temperature lead to flares and rashes and joint pain are related to humidity,” adds Dr. Garg. “This study validates what patients have been talking about.” The study may also one day provide patients with a way to actively do something to prevent their flares, which is important for patients, Garg explains. “If we know the triggers, we may be able to educate patients and say, ‘Today, you need more sunscreen protection,’ or ‘If your workplace is by a hot stove in a restaurant kitchen, you may want to find a way to adjust your work environment during times when you’re likely to have a flare,’” says Garg. Access to that type of information could vastly improve disease management for those individuals and quality of life, says Garg. In the meantime, individuals with lupus can follow general advice about how to avoid lupus flares. The Lupus Foundation of America recommends trying to avoid known triggers, such as emotional and physical stress, colds or other viral illnesses, and exhaustion. “It’s too early to infer any definite connection between the environmental factors we analyzed and lupus flares, and more studies are needed before any definite recommendations can be given,” says Stojan. But, he says, there are some general precautions all patients with lupus should follow, like avoiding the sun, as sunlight can cause rashes and flares.
