Posted November 2, 2022

George Stojan, M.D., Johns Hopkins University

The Johns Hopkins University received fiscal year 2018 funding from the Congressionally Directed Medical Research Programs’ Lupus Research Program to pursue work on a proposal submitted by Dr. George Stojan. The proposal, titled “A Spatial Temporal Analysis of Organ-Specific Lupus Flares in Relation to Atmospheric and Environmental Factors,” examines the association between environmental triggers and organ-specific disease flares in systemic lupus erythematosus (SLE). SLE is a progressive, multisystem autoimmune disease that is severely debilitating and is the result of dysfunctional immune regulation. The condition has both genetic and environmental risk factors.

This study, a novel analysis of spatiotemporal clusters in the Hopkins Lupus Cohort, used data from the Environmental Protection Agency and the National Oceanic and Atmospheric Administration to identify environmental patterns associated with SLE disease flares.

A total of 1,628 patients who fulfilled the Systemic Lupus International Collaborating Clinics classification criteria for SLE and had a home address recorded were included in the analysis. Disease activity was assessed using the Lupus Activity Index. The Principal Investigator (PI), Dr. Stojan, collected data on fine particulate matter pollution (PM2.5), temperature, ozone concentration, wind patterns, barometric pressure, and relative humidity. The average value of each factor 10 days prior to patient visit was calculated and statistically analyzed to determine potential associations with lupus disease activity.

The ultimate purpose of the study was to better understand lupus heterogeneity and to develop a basis for further research on the role of environmental and atmospheric factors in the development and progression of SLE. In this, the PI was successful. His research identified large-scale, multi-year spatiotemporal clusters of lupus organ-specific flares that did not conform to any previously described infectious or environmental clusters. The cluster patterns differed in extent and location for the various organ-specific flare types (i.e., rash, joint involvement, serositis, neurologic, pulmonary, renal, and hematologic). Most of the identified clusters (except serositis) changed in significance, temporal, or spatial extent after adjusting for environmental covariates, indicating that the clusters were at least partially driven by the environmental covariates. The outcomes of the study are important as an initial analysis of environmental effects on SLE disease activity and will be useful as a basis for future research to further clarify the role of environmental factors on SLE pathogenesis and heterogeneity, as well as potentially form the basis for predictive models of lupus flares. The results of the study were published in the peer-reviewed journal, Arthritis & Rheumatology.¹

Reference:
¹Stojan G, Kvit A, Curriero FC, and Petri M. 2020. A spatiotemporal analysis of organ-specific lupus flares in relation to atmospheric variables and fine particulate matter pollution. Arthritis & Rheumatology 72(7):1134-1142. doi: 10.1002/art.41217. Epub 2020 May 2. PMID: 32017464; PMCID: PMC7329611.

Links:
Public and Technical Abstracts: A Spatial Temporal Analysis of Organ-Specific Lupus Flares in Relation to Atmospheric and Environmental Factors

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