Predicting the Impact of Air Quality Index on Rheumatoid Arthritis Disease Activity.

Abstract

Aim and objective: This study explored the relationship between air pollution and rheumatoid arthritis (RA), focusing on how specific air quality components affect RA disease activity as measured by Disease Activity Score 28 (DAS28).

Methods: The research involved Data were obtained from six air-monitoring stations across Kuwait, and RA patient information was obtained from the Kuwait Registry for Rheumatic Diseases (KRRD). This study analyzed the impact of pollutants such as sulfur dioxide (SO₂), nitrogen dioxide (NO₂), ozone (O₃), particulate matter (PM₁₀), nitrogen oxide (NO), and carbon monoxide (CO) on the DAS28.

Results: The results highlighted that NO₂ and O₃ were the most significant air quality index (AQI) components influencing DAS28 scores. NO₂ had a lag effect of two months (p < 0.01, effect score = 0.43), while O₃ exhibited a lag effect of three months (p < 0.05, effect score = 0.31), both correlating with increased RA disease activity. The study utilized a Vector Error Correction Model (VECM) and co-integration analysis to examine short- and long-term associations between predicted and actual DAS28 scores was corrected over the following year, indicating that strong long-term cointegration with the Error Correction (EC1) term was negative and significant (-0.54, p < 0.001).

Conclusions: These findings emphasize the importance of air quality management in mitigating the impact of environmental factors on RA, suggesting that exposure to elevated levels of NO₂ and O₃ beyond regulatory standards could exacerbate RA symptoms. This study provides a foundation for future public health interventions aimed at improving disease prognosis in patients with RA by addressing environmental factors, such as air pollution.