‘Rising Cases of Rheumatoid Arthritis in Delhi Could Be Linked to Air Pollution’: Report
New Delhi: Air pollution – specifically fine particulate pollution – could be causing a spike in cases of rheumatoid arthritis (RA) in Delhi-NCR, said rheumatologists at the 40th annual conference of the Indian Rheumatology Association held from October 9 to 12 in New Delhi.
Per a report on the conference by the Indian Express, experts said that there is a surge in both the number and intensity of rheumatoid arthritis in the national capital. Even people without a genetic predisposition to it are now contracting the disease, they added.
Per the World Health Organisation, rheumatoid arthritis (RA) is a chronic autoimmune disease that causes inflammation around the body and commonly presents with pain in the joints. It can affect multiple body systems such as the joints of hands, wrists, feet, ankles, knees, shoulders and elbows. The disease has no cure: the pain it causes can only be managed depending on the severity of the case.
Delhi’s rising RA cases
Doctors and researchers at the conference said that they were observing a trend of an increase in both the number and severity of RA cases in the Delhi-NCR region.
The Indian Express quoted Dr. Pulin Gupta, Professor and Rheumatologist at Dr. Ram Manohar Lohia Hospital, as saying that reduced green spaces in urban areas are worsening the problem, because the lack of green spaces deprive residents of protective environmental buffers. He also pointed to how recent studies show “strong associations between exposure to PM2.5, nitrogen oxides, and ozone with increased risk of RA cases, especially in genetically susceptible individuals”. He noted that studies show that living near busy roads — which means constant exposure to traffic-related pollution — has also been linked to higher RA risk.
Quoting a recent “landmark study”, Dr. Gupta said that there was “strong genetic evidence” connecting air pollution to autoimmune diseases, including RA, per the news report. According to him, the study shows that environmental damage is now a crucial driver in the rise of these diseases. The study that Dr. Gupta referred to is published in the journal Scientific Reports and shows evidence of a causal relationship between air pollutants and specific autoimmune disease risks, including RA.
Delhi being one of the top 10 most polluted cities in the world is “a hotbed of concern”, Dr. Gupta said.
‘Turning healthy individuals into patients’
Rheumatoid arthritis has been traditionally linked to genetics and immune system dysfunction. However, there is now a body of evidence such as this one that shows that it is increasingly being associated with environmental triggers such as air pollution. Per Indian Express, experts at the conference suggested that RA already affects around 1% of India’s adult population.
“We are observing a rise in RA cases in patients living in polluted areas with no family history or genetic predisposition to autoimmune disease,” Indian Express quoted Dr. Uma Kumar, Head of Rheumatology at AIIMS Delhi, as saying.
Per the news report, Dr. Kumar said that the conditions of RA patients who are otherwise doing well also worsens when pollution levels are high.
“This is a public health emergency we can no longer ignore,” she said, adding that most of these patients are in the 20-50 age group.
The Indian Express report also quoted Dr. Neeraj Jain, Scientific Chairman and Vice Chairman, Department of Rheumatology at Sir Ganga Ram Hospital, as saying that “pollution is rewriting that narrative” and “turning healthy individuals into patients”.
“The fact that young people with no family history are developing RA should set alarm bells ringing,” the news report quoted Dr. Jain as saying.
He added that research conducted in China showed that long-term exposure to PM2.5 was associated with a 12%-18% increased risk of developing RA. “European cohorts similarly reported that people living in highly polluted cities had significantly higher morbidity related to autoimmune disorders. These findings mirror what doctors are now observing… with Delhi residents facing a double blow of respiratory distress and autoimmune flare-ups,” he added.
Doctors at the conference also said that the prevalence of RA in Delhi-NCR and other such polluted areas could increase with the increase in pollution levels.
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