THE RELATIONSHIP BETWEEN ENVIRONMENTAL FACTORS AND THE DEVELOPMENT OF RHEUMATIC DISEASES: SYSTEMATIC REVIEW

Abstract

Background: Rheumatic diseases, such as rheumatoid arthritis (RA) and dermatomyositis, are chronic autoimmune conditions whose development cannot be fully explained by genetic predisposition alone. This systematic review investigates the role of environmental factors in the initiation and progression of these diseases.

Methods: Following PRISMA guidelines, a comprehensive search was conducted across multiple electronic databases (PubMed, Scopus, Web of Science, Google Scholar) for studies published up to December 2024. Eligible studies included original research examining environmental exposures (e.g., air pollution, occupational inhalants, smoking, diet, ultraviolet radiation) and their association with rheumatic disease outcomes. Data were extracted and synthesized narratively due to heterogeneity.

Results: From 1,246 identified records, 11 studies comprising over 500,000 participants were included. Air pollution (PM₂.₅, SO₂, NO₂) was consistently associated with increased RA risk and autoantibody positivity (e.g., ACPA). Occupational exposures (e.g., silica, toluene) significantly elevated RA risk, particularly in men and when combined with smoking and genetic susceptibility (OR up to 18.22). Smoking showed mixed effects, while ultraviolet radiation increased dermatomyositis risk. A Mediterranean diet exhibited a protective effect, but only among smokers. Gene-environment interactions consistently amplified disease risk.

Conclusion: Environmental factors—including air pollution, occupational inhalants, smoking, UV exposure, and diet—play a significant and often synergistic role in the development of rheumatic diseases, especially in genetically susceptible individuals. These findings highlight the importance of environmental risk assessment and targeted public health interventions for disease prevention.