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Influence of exposure to climate-related hazards in the phenotypic expression of primary Sjögren's syndrome

1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43
Collaborator/s: X. Dong1, Z. Yan2, X. Li3, L. Wang4, P. Olsson5, T. Mandl6, R. Seror7, X. Mariette8, A. Vissink9, H. Bootsma10, D. Danda11, V.C. Romão12, M. Bandeira13, M. Silvério-António14, R. Solans15, C. Galisteo16, D. Sene17, D. Isenberg18, P. Cipriani19, V. Devauchelle20, T. Gheita21, M. Vázquez22, J. Morel23, S. Consani24, S.-K. Kwok25, S.-H. Park26, M. Kvarnstrom27, M. Wahren-Herlenius28, P.E. Diaz29, B. Herrera30, T. Shimizu31, A. González García32, S. Melchor-Díaz33, M. Bombardieri34, A. Lees35, S. Arends36, E. Treppo37, S. Longhino38, V. Manfrè39, M.T. Rizzo40, B. Fazzi41, A. Sebastian42, P. Wiland43, R. Gerli44, S. Downie-Doyle45, A. Saraux46, C. Morcillo47, L. González-De-Paz48, A. Sisó-Almirall49, C. Fugmann50

 

  1. Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, Spain.
  2. Autoimmune Diseases Unit, Research and Innovation Group in Autoimmune Diseases, Sanitas Digital Hospital, Hospital-CIMA-Centre Mèdic Milenium Balmes Sanitas, Barcelona, Spain.
  3. Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, and NIHR Biomedical Research Centre & NIHR Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
  4. Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Hungary.
  5. Genes and Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA.
  6. Department of Internal Medicine and Medical Specialties, Rheumatology Clinic, Sapienza University of Rome, and Saint Camillus International University of Health Science, UniCamillus, Rome, Italy.
  7. Rheumatology Unit, University of Pisa, Italy.
  8. Division of Rheumatology, Department of Internal Medicine, Hacettepe University, Faculty of Medicine, Ankara, Turkey.
  9. Department of Internal Medicine, Division of Rheumatology, Gazi University School of Medicine, Ankara, Turkey.
  10. Department of Rheumatology, University Medical Centre, Ljubljana, Slovenia.
  11. Division of Rheumatology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan.
  12. Division of Rheumatology, University of Udine, Department of Medicine, University Hospital Santa Maria della Misericordia, Udine, Italy.
  13. Immunology and Rheumatology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, Mexico.
  14. Marmara University, School of Medicine, Istanbul, Turkey.
  15. Rheumatology Unit, Department of Medicine, University of Perugia, Italy.
  16. Department of Rheumatology, The Queen Elizabeth Hospital, Discipline of Medicine, University of Adelaide, South Australia, Australia.
  17. Ribeirao Preto Medical School, University of São Paulo, Brazil.
  18. Division of Health Based Evidence, Federal University of São Paulo, Brazil.
  19. Department of Internal Medicine, Carol Davila Central Military Emergency Hospital, Bucharest, Romania.
  20. Rheumatology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
  21. Internal Medicine and Nephrology Unit, Department of Medicine, ASL Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy.
  22. Otorhinolaryngology, Head and Neck Surgery, Technical University Munich, Germany.
  23. University Hospital Cassiano Antonio Moraes (Hucam-Ufes/Ebserh), Federal University of Espírito Santo, Brazil.
  24. Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, Brazil.
  25. Department of Rheumatology, Hospital Quirón Salud, Barcelona, Spain.
  26. Rheumatology Unit, University of Messina, Italy.
  27. Department of Internal Medicine, Hospital de Cabueñes, Gijón, Spain.
  28. Department of Internal Medicine, Hospital Joan XXIII, Tarragona, Spain.
  29. Fondazione Policlinico Universitario Campus Bio-Medico, Roma, and Research Unit of Immuno-Rheumatology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Italy.
  30. Division of Haematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Oyaguchi Kami-cho, Itabashi-ku, Tokyo, Japan.
  31. Department of Internal Medicine, Hospital Infanta Leonor, Madrid, Spain.
  32. Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, and NIHR Biomedical Research Centre & NIHR Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
  33. Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Hungary.
  34. Genes and Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA.
  35. Department of Internal Medicine and Medical Specialties, Rheumatology Clinic, Sapienza University of Rome, and Saint Camillus International University of Health Science, UniCamillus, Rome, Italy.
  36. Rheumatology Unit, University of Pisa, Italy.
  37. Division of Rheumatology, Department of Internal Medicine, Hacettepe University, Faculty of Medicine, Ankara, Turkey.
  38. Department of Internal Medicine, Division of Rheumatology, Gazi University School of Medicine, Ankara, Turkey.
  39. Department of Rheumatology, University Medical Centre, Ljubljana, and Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Slovenia.
  40. Division of Rheumatology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan.
  41. Division of Rheumatology, University of Udine, Department of Medicine, University Hospital Santa Maria della Misericordia, Udine, Italy.
  42. Marmara University, School of Medicine, Istanbul, Turkey.
  43. Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, and Department of Medicine, University of Barcelona, Spain. mramos@clinic.cat

  1. Department of Rheumatology, Peking Union Medical College Hospital, Beijing, China.
  2. Department of Rheumatology, Peking Union Medical College Hospital, Beijing, China.
  3. Department of Rheumatology and Immunology, The First Affiliated Hospital of USTC, University of Science and Technology of China (Anhui Provincial Hosipital), Hefei, China.
  4. Department of Rheumatology and Immunology, The First Affiliated Hospital of USTC, University of Science and Technology of China (Anhui Provincial Hosipital), Hefei, China.
  5. Department of Rheumatology, Skane University Hospital Malmö, Lund University, Lund, Sweden.
  6. Department of Rheumatology, Skane University Hospital Malmö, Lund University, Lund, Sweden.
  7. Center for Immunology of Viral Infections and Autoimmune Diseases, Assistance Publique, Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicêtre, Université Paris Sud, INSERM, Paris, France.
  8. Center for Immunology of Viral Infections and Autoimmune Diseases, Assistance Publique, Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicêtre, Université Paris Sud, INSERM, Paris, France.
  9. Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, The Netherlands.
  10. Department of Oral and Maxillofacial Surger, University of Groningen, University Medical Center Groningen, The Netherlands.
  11. Department of Clinical Immunology and Rheumatology, Christian Medical College and Hospital, Vellore, India.
  12. Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte and Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon Academic Medical Centre, Lisbon, Portugal.
  13. Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte and Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon Academic Medical Centre, Lisbon, Portugal.
  14. Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte and Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon Academic Medical Centre, Lisbon, Portugal.
  15. Department of Internal Medicine, Hospital Vall d'Hebron, Barcelona, Spain.
  16. Department of Rheumatology, Hospital Parc Taulí, Barcelona, Spain.
  17. Hôpital Lariboisière, Paris, France.
  18. University College of London, UK.
  19. Clinical Unit of Rheumatology, University of l'Aquila, School of Medicine, L'Aquila, Italy.
  20. Cavale Blanche-University Hospital, Brest, France.
  21. Rheumatology Department, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt.
  22. Department of Rheumatology, Hospital de Clínicas, San Lorenzo, Paraguay.
  23. Department of Rheumatology, Teaching Hospital and University of Montpellier, France.
  24. Internal Medicine, Hospital Maciel, and Universidad de la República (UdelaR), Montevideo, Uruguay.
  25. Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
  26. Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
  27. Department of Medicine, Solna, Division of Experimental Rheumatology, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden.
  28. Department of Medicine, Solna, Division of Experimental Rheumatology, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden.
  29. Departamento de Reumatología del Seguro Social Universitario y consultorio privado de Reumatología, Sucre, Bolivia.
  30. Departamento de Reumatología del Seguro Social Universitario y consultorio privado de Reumatología, Sucre, Bolivia.
  31. Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
  32. Department of Internal Medicine, Hospital 12 de Octubre, Madrid, Spain.
  33. Department of Rheumatology, Hospital 12 de Octubre, Madrid, Spain.
  34. Queen Mary University of London, London, UK.
  35. Westmead Hospital, Sydney, Australia.
  36. Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, The Netherlands.
  37. Division of Rheumatology, University of Udine, Department of Medicine, University Hospital Santa Maria della Misericordia, Udine, Italy.
  38. Division of Rheumatology, University of Udine, Department of Medicine, University Hospital Santa Maria della Misericordia, Udine, Italy.
  39. Division of Rheumatology, University of Udine, Department of Medicine, University Hospital Santa Maria della Misericordia, Udine, Italy.
  40. Division of Rheumatology, University of Udine, Department of Medicine, University Hospital Santa Maria della Misericordia, Udine, Italy.
  41. Division of Rheumatology, University of Udine, Department of Medicine, University Hospital Santa Maria della Misericordia, Udine, Italy.
  42. Department of Rheumatology and Internal Medicine, Wroclaw Medical University, Wroclaw, Poland.
  43. Department of Rheumatology and Internal Medicine, Wroclaw Medical University, Wroclaw, Poland.
  44. Rheumatology Unit, Department of Medicine, University of Perugia, Italy.
  45. Department of Rheumatology, The Queen Elizabeth Hospital, University of Adelaide, South Australia, Australia.
  46. Rheumatology Department, Brest University, INSERM 1227, Brest, France.
  47. Hospital Digital Sanitas, Hospital CIMA-Sanitas, Barcelona, Spain.
  48. Primary Healthcare Transversal Research Group, IDIBAPS, Primary Care Center Les Corts, CAPSBE, Barcelona, Spain.
  49. Primary Healthcare Transversal Research Group, IDIBAPS, Primary Care Center Les Corts, CAPSBE, Barcelona, Spain.
  50. Rheumatology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.

on behalf of the Sjögren Big Data Consortium

CER17180
2023 Vol.41, N°12
PI 2437, PF 2447
Full Papers

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PMID: 38019164 [PubMed]

Received: 28/09/2023
Accepted : 24/10/2023
In Press: 27/11/2023
Published: 23/12/2023

Abstract

OBJECTIVES:
To analyse how the key components at the time of diagnosis of the Sjögren’s phenotype (epidemiological profile, sicca symptoms, and systemic disease) can be influenced by the potential exposure to climate-related natural hazards.
METHODS:
For the present study, the following variables were selected for harmonisation and refinement: age, sex, country, fulfilment of 2002/2016 criteria items, dry eyes, dry mouth, and overall ESSDAI score. Climate-related hazards per country were defined according to the OECD and included seven climate-related hazard types: extreme temperature, extreme precipitation, drought, wildfire, wind threats, river flooding, and coastal flooding. Climatic variables were defined as dichotomous variables according to whether each country is ranked among the ten countries with the most significant exposure.
RESULTS:
After applying data-cleaning techniques and excluding people from countries not included in the OECD climate rankings, the database study analysed 16,042 patients from 23 countries. The disease was diagnosed between 1 and 3 years earlier in people living in countries included among the top 10 worst exposed to extreme precipitation, wildfire, wind threats, river flooding, and coastal flooding. A lower frequency of dry eyes was observed in people living in countries exposed to wind threats, river flooding, and coastal flooding, with a level of statistical association being classified as strong (p<0.0001 for the three variables). The frequency of dry mouth was significantly lower in people living in countries exposed to river flooding (p<0.0001) and coastal flooding (p<0.0001). People living in countries included in the worse climate scenarios for extreme temperature (p<0.0001) and river flooding (p<0.0001) showed a higher mean ESSDAI score in comparison with people living in no-risk countries. In contrast, those living in countries exposed to worse climate scenarios for wind threats (p<0.0001) and coastal flooding (p<0.0001) showed a lower mean ESSDAI score in comparison with people living in no-risk countries.
CONCLUSIONS:
Local exposure to extreme climate-related hazards plays a role in modulating the presentation of Sjögren across countries concerning the age at which the disease is diagnosed, the frequency of dryness, and the degree of systemic activity.

DOI: https://doi.org/10.55563/clinexprheumatol/pmbay6

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