Environmental and occupational contributors to autoimmune, inflammatory, and musculoskeletal rheumatic disease: a review of emerging evidence and clinical implications.

Abstract

Purpose of review: Autoimmune and inflammatory rheumatic diseases as well as certain musculoskeletal diseases treated by rheumatologists result from a complex interplay between genetic predisposition and environmental factors.

Recent findings: Accumulating research has examined the possible roles of physical trauma, psychological stress, pollutants, and occupational exposures as triggers or influencers of disease. We review and summarize existing evidence for these contributors for conditions including rheumatoid arthritis, systemic lupus erythematosus, psoriatic arthritis, spondyloarthritis, systemic sclerosis, Sjogren's syndrome, vasculitis, myositis and fibromyalgia. We highlight findings from case-control, cohort, and twin studies that associate trauma, chronic stress and environmental exposure with immune dysregulation and increased disease risk. We apply the GRADE framework to assess the strength of evidence and identify key research gaps. Summary tables are included to guide clinical assessment which could also support interdisciplinary communication in medico-legal contexts.

Summary: These data have implications for disease etiopathogenesis; management; historical appreciation; public health, policy and safety; and legal considerations.