'They Might Amputate My Legs': 29-Year-Old Fights Psoriatic Arthritis - Warning Signs To Watch For

From ndtv.com

Psoriatic arthritis (PsA) is a chronic inflammatory condition that affects the joints and can develop in people with psoriasis. It is an autoimmune disease, which means the immune system mistakenly attacks healthy tissues, causing inflammation.

Phoebe Phillips, a 29-year-old, says that she is facing the possibility of a double leg amputation after years of severe inflammatory arthritis damaged both her knees. The woman was diagnosed with psoriatic seronegative inflammatory oligoarthritis in March 2019, after her right knee suddenly became severely swollen and painful in late 2018. Over the years, she says she tried several medicines, including methotrexate, sulfasalazine, JAK inhibitors and biologic drugs, but her disease continued to progress. By April 2026, an X-ray showed that she had no cartilage remaining in her knees, which has made walking incredibly difficult.

"I've missed out on my entire adulthood so far," said Phoebe, according to a report in Mirror. "It's really the small things that are so much more important to me. Just to be able to go up and down a couple of stairs like a normal person.. Standing in the shower and not having to sit down - all the small stuff.

"I can't even sleep in a normal bed, I have a rail next to the toilet, and all those kinds of things that I just shouldn't have to be dealing with, if I'd have been taken more seriously sooner or listened to."

Phoebe says she needed to repeatedly advocate for herself and feels her concerns were not taken seriously early enough. She now has severely restricted movement, permanently bent legs and difficulty carrying out everyday activities such as climbing stairs, sleeping comfortably and standing in the shower. Doctors have advised that double knee replacement may be necessary and the procedure might have to be repeated every 10 years. She says she has also been warned that repeated replacement surgeries and bone loss could eventually make above-knee amputation necessary. However, Phoebe said that it is a risk she is willing to take.

What Is Psoriatic Arthritis?

Psoriatic arthritis (PsA) is a chronic inflammatory condition that affects the joints and can develop in people with psoriasis. It is an autoimmune disease, which means the immune system mistakenly attacks healthy tissues, causing inflammation.

Psoriatic arthritis may lead to cartilage loss, bone damage, deformity, stiffness, and other problems   Unsplash

Although psoriasis often appears as red, scaly skin patches, PsA can affect the joints even when skin symptoms are mild or absent. It may affect the knees, fingers, toes, ankles, elbows, spine and the joints connecting the spine to the pelvis. Unlike ordinary wear-and-tear arthritis, PsA can cause inflammation that progressively damages cartilage, bone and other structures around the joints if it is not adequately controlled.

Types Of Psoriatic Arthritis

Psoriatic arthritis can appear in different patterns. The main types include:

• Asymmetric oligoarthritis: Affects a small number of joints, often on one side of the body
• Symmetric polyarthritis: Affects several joints on both sides of the body and can resemble rheumatoid arthritis
• Distal arthritis: Mainly affects the joints closest to the fingertips and toenails
• Spondylitis: Causes inflammation and stiffness in the spine and sacroiliac joints
• Arthritis mutilans: A rare but severe form that can cause major destruction of the joints and bones in the hands and feet

Warning Signs To Watch For

Symptoms can vary considerably, but common warning signs include:

• Persistent joint pain, swelling or stiffness
• Stiffness that is worse in the morning or after periods of inactivity
• Swollen fingers or toes, sometimes described as "sausage digits"
• Pain around the heels or where tendons attach to bones
• Lower back or buttock pain linked to inflammation
• Nail changes such as pitting, ridges or separation from the nail bed
• Psoriasis or a history of psoriasis
• Reduced movement or difficulty using an affected joint
• Fatigue

What Causes Psoriatic Arthritis?

There is no single known cause. PsA develops through a combination of genetic, immune-system and environmental factors.

Genes can increase susceptibility, which is why having a close relative with psoriasis or PsA can raise the risk. The immune system then becomes abnormally activated and triggers inflammation in the joints, tendons and other tissues.

Certain environmental factors may also contribute, including infections, physical trauma and other immune triggers. However, having psoriasis does not mean a person will definitely develop PsA.

Who Is At Higher Risk?

People with psoriasis are at increased risk of developing PsA, particularly those with extensive skin disease or certain nail changes. A family history of psoriasis or PsA can also increase susceptibility.

PsA can develop at any age, although it commonly begins in adulthood. Other factors, including obesity, smoking and some environmental triggers, may also be associated with a higher risk. It is important to note that the condition can also occur in people who have not previously been diagnosed with psoriasis.

What Happens If Psoriatic Arthritis Is Not Controlled?

Persistent inflammation can gradually damage joints. Over time, this may lead to cartilage loss, bone damage, deformity, stiffness and significant loss of mobility.

People with severe disease may struggle with walking, working, exercising or performing routine activities. Chronic pain and fatigue can also affect sleep, mental wellbeing and quality of life. PsA is not limited to the joints. It is also linked with an increased risk of other health problems, including cardiovascular disease, obesity, diabetes, inflammatory bowel disease and eye inflammation. Therefore, regular medical monitoring is important.

Can Joint Damage Be Prevented?

There is currently no cure for PsA, but treatments can control inflammation and reduce the risk of permanent joint damage. Treatment may include conventional disease-modifying antirheumatic drugs, biologic medicines and targeted therapies, depending on the individual's symptoms and disease pattern.

Painkillers and physical therapy may help manage symptoms, but they do not necessarily control the underlying inflammation. Treatment therefore needs to focus on suppressing disease activity as well as improving movement.

Disclaimer: This content including advice provides generic information only. It is in no way a substitute for a qualified medical opinion. Always consult a specialist or your own doctor for more information. NDTV does not claim responsibility for this information.

https://www.ndtv.com/health/they-might-amputate-my-legs-29-year-old-fights-psoriatic-arthritis-warning-signs-to-watch-for-11900593 

Saina Nehwal’s arthritis diagnosis: How years of competitive sport can impact body

From indianexpress.com

The former Olympic medallist recently opened up about retiring because of arthritis. An orthopaedic surgeon explains why elite athletes may develop arthritis early, the warning signs to watch for and how to stay active after diagnosis

Ace shuttler Saina Nehwal recently spoke candidly about how arthritis brought her illustrious badminton career to an end. During an interview with Hauterrfly, when asked, “When you retire because of arthritis, it must be so hard for you,” the former Olympic medallist reflected on life after stepping away from competitive sport.

“It hurts a lot, you know, when you play some sport for 25 years. Every day is like a challenge; you have to fight, you have to just give your best. So it feels like life has become a little easier, and how do I make it even tougher every day? So that becomes a challenge,” she said.

Arthritis is often viewed as a condition that affects older adults. But can years of high-intensity training, repeated impact and sports injuries cause joints to wear out much earlier? Dr Sanjeev Jain, Chief of Orthopaedics (HOD) & Joint Replacement Surgeon, KIMS Hospitals, Thane, explains.

                                                     Saina Nehwal on artritis diagnosis (Photo: Instagram/nehwalsaina)

Can years of competitive sport lead to arthritis at a younger age?

According to Dr Jain, the answer is yes—especially for elite athletes whose joints endure years of repetitive stress. “Certainly, it can. Because of their years of training, competition and vigorous movement, elite athletes subject their joints to repeated stress.”

Sports that involve frequent jumping, sudden changes in direction and repetitive impact can gradually damage the protective cartilage inside joints.

“Sports which include a lot of jumping, frequent changes in direction and heavy impact can slowly deteriorate the cartilage,” he explains.

The risk rises significantly if an athlete has previously sustained serious joint injuries. “The risk is even greater if the athlete has already suffered ligament injuries, meniscus tears or fractures since these conditions can change the way the joint functions and accelerate cartilage damage,” he adds.

However, Dr Jain points out that arthritis is not inevitable. “While not all athletes go on to develop arthritis, a long sporting career together with past injuries can lead to osteoarthritis appearing earlier than would be expected.”

What are the early warning signs athletes shouldn’t ignore?

According to Dr Jain, arthritis often begins subtly. “The first signs are usually mild and can easily be regarded as just normal aches.”

He says athletes and physically active individuals should watch out for:

* Persistent joint pain
* Morning stiffness or stiffness after periods of inactivity
* Swelling around the joint
* Reduced flexibility
* Clicking or grinding sensations
* Pain that returns during activity
* Longer recovery after training sessions

“Some athletes also find that their recovery time after training is longer than it used to be,” he adds.

Ignoring these symptoms can delay treatment. “When joint pain lasts for several weeks, keeps coming back, hampers performance or is accompanied by swelling or instability, it is important to see an orthopaedic specialist. Early diagnosis may help in slowing down the progression and in maintaining joint function,” he explains.

Does arthritis mean you have to stop exercising?

Dr Jain says remaining active is one of the most effective ways to manage arthritis and maintain joint health. “Receiving a diagnosis of arthritis doesn’t mean that one has to stop exercising. On the contrary, remaining active is one of the best methods for keeping your joints in good condition.”

The focus, however, should shift from high-impact activities to joint-friendly exercises. “Instead of concentrating on high-impact activities, you should turn to exercises that are kind to the joints, such as swimming, cycling, walking, yoga and strength training under supervision,” he explains.

Increasing the amount of muscle surrounding the joint in question helps to improve stability and lessens pain. He also recommends combining exercise with other lifestyle measures.

“Weight management, physiotherapy, wearing good footwear and making changes to the way you are active are also important factors. The aim is to stay active while at the same time protecting the joints, not to entirely avoid movement,” he adds.

DISCLAIMER: This article is based on information from the public domain and/or the experts we spoke to. Always consult your health practitioner before starting any routine.

https://indianexpress.com/article/lifestyle/health/saina-nehwals-arthritis-diagnosis-how-years-of-competitive-sport-can-impact-body-10816299/ 

The best exercises to ease arthritic hips and knees

From telegraph.co.uk 

By Dr Thomas Naylor

One orthopaedic doctor reveals the movements and stretches shown to both delay progression of the disease and prevent the onset of symptoms

I’ve seen over and over how patients with arthritis become inactive over fear of damaging their joints. I think orthopaedic doctors are in part to blame. We used to refer to osteoarthritis, the most common form of the disease, as “wear and tear”.

That phrase puts the idea in patients’ heads that their joints have worn away because they’ve used them too much. We know that’s not the case – your genes determine whether your cartilage will break down, or a previous injury may have damaged the surface of the joint – and a recent study from Arthritis UK has in fact found that exercise is the most effective way to reduce pain and improve mobility.

This reinforces what doctors have suspected for quite a while but now know: Physical activity is beneficial for – and protective against – all forms of arthritis, rather than causing more damage to arthritic hips and knees.

There are a number of reasons for this. Movement flushes fluid through cartilage – the smooth, slippery surface that coats the end of our bones so they can glide smoothly against each other – keeping them healthy and mobile.

Then there is the increase in strength and range of movement around the joint, as well as the very nature of being active and getting your blood flowing. All of these benefits compound on one another and make getting back into exercise the best thing you can do for painful, arthritic joints.

It can be difficult to get arthritis patients on board with exercise, but I promise it’s worth persevering. I’ve seen patients go from “I can’t go on, I need a hip replacement” to “my symptoms have improved, I don’t need surgery”.

Your new exercise routine

Dr Thomas Naylor demonstrates a standing hip abduction, one of the exercises he recommends to ease arthritis symptoms Credit: Jon Super

I’ve shared seven exercises and three stretches meant to ease arthritic hips and knees, delay its progression and even prevent the onset of arthritic symptoms in those who don’t have them yet.

Expect some discomfort if you haven’t exercised in a while, especially when doing the moves that target your range of movement. A joint that hasn’t been moved much will no longer want to move. It’s important to push through the pain, as the knee and hip will eventually become more supple and the day-to-day pain from your arthritis will reduce dramatically.

Ease yourself into this routine, being conservative with the number of repetitions. While these moves may seem simple, your stabilising muscles will be working quite hard and you may experience delayed onset muscle soreness in the following days.

This routine works best if you do it at least three times a week, and you will really feel the benefit after three months. From that point you can progress back to the activity you enjoy doing, whether that’s walking, swimming, cycling or any other sport.

If your joint pain gets progressively worse after a few weeks of following this routine, however, I would recommend seeing your GP or a musculoskeletal practitioner.

For each exercise, aim for three sets of 10 repetitions. For the stretches, hold for at least 20 seconds. Increase the number of repetitions and the duration of stretch in line with what you feel able to do.

Exercises

Seated knee extension

Arthritis benefit: Improves knee range of movement and strengthens the quadriceps (thigh muscles)

Sit on a chair with your feet resting on the floor. Keep one foot planted flat on the ground and, with your back braced against the back of the chair, straighten the other leg out in front of you. Hold that position for about five seconds, contracting the quadriceps. Relax and lower your foot to the ground. Repeat for one side as many repetitions as able, and then swap sides.

Modification: If you can’t get your leg completely straight, aim for as straight as you can. Your muscles will still be working hard, and your range of motion should increase over time.

Sit to stand

Arthritis benefit: Strengthens quadriceps and glutes and improves hip and knee mobility

Sit in a chair and rest your arms on your lap or by your side. Without pushing up with your hands, stand up. When standing, maintain good posture and push your hips forward.

Modification: Try a supported squat. Stand up with your hands on a sturdy surface, with a seat behind you, in case you lose balance. Bend your knees and lower yourself, as if you are going to sit on the chair, without doing so. Go as low as you can safely go, before standing back up.

Standing hip abduction

Arthritis benefit: Strengthens the glutes and hip abductors to stabilise the hip joint

Stand with your hands on a chair in front of or beside you. Lift one leg sideways, as high as you can, in a straight line from the side of your body, keeping your toes pointing forward. Hold this position for five seconds before lowering your leg to the floor. Repeat for one side as many repetitions as you are able, and then swap sides.

Modification: If you struggle with this exercise, lower your leg. As you get stronger and improve your range of motion, you will be able to raise your leg higher for longer. You can make it more challenging by using ankle weights to increase the load.

Standing knee raise

Arthritis benefit: Works the hip flexors, increasing the range of movement in the hip joint

Stand next to a chair, resting one hand on it for balance. Raise one leg in front of you, bending at the knee, as if you are going to kick out. Aim to have your thigh horizontal with the floor.

Modification: Lift your knee only as high as you feel comfortable.

Lying leg raise

Arthritis benefit: Engages the quadriceps and hip flexors to reduce pressure on the joint and improve hip and knee control

Lie on the floor with your legs straight and arms by your sides. Lift one leg off the floor, keeping it as straight as you can, while your resting leg remains flat and your back is flat on the floor. Hold your leg in the air for five seconds before lowering it.

Modification (displayed above): If this is too difficult, bend the knee of your resting leg so your foot is flat on the floor. This takes some of the weight off the quadriceps, making it easier to raise your leg.

Heel slides

Arthritis benefit: Improves range of movement in the knee and the hip while working the hamstrings (thigh muscles)

Lie flat on the floor. Bend one knee, keeping that foot flat on the ground. Slide your foot as close to your bum as possible and hold it there for five seconds. Slowly slide your foot back to the starting position.

Modification: If you are struggling to bring the hip and knee bent using just your leg muscles, you can use a towel looped around the ankle and help to pull the leg bent with your arms too.

Step-up

Arthritis benefit: Strengthens the quadriceps and glutes and improves movement control

Stand facing your stairs or an aerobic step. Place your foot on the step and push through it to bring your other foot onto the step. Step back down slowly, one foot at a time.

Modification: The smaller the step you use, the easier this will be. Once your confidence and control grow, you can do bigger steps or two steps at a time.

Stretches

Knee extensions

Arthritis benefit: Improves the knee’s range of movement and activates the quadriceps

Sit on the floor with your back against the wall and your legs straight in front of you. Keep one leg bent and with the foot planted flat on the floor. Roll up a towel and place it under your ankles so your straight leg is slightly elevated. Contract your thigh muscles and push the knee down towards the floor. For an even deeper stretch, use your hands to gently push down on your knee.

Hip flexor stretch

Arthritis benefit: Improves flexibility in the ligaments around the hip

Lie flat on the floor. Bend one knee up to your chest and hold the back of your thigh or the front of your knee, pulling the knee as close to your chest as possible. Repeat on the other side.

Lying hip external rotation

Arthritis benefit: Rotating the hip outwards to improve range of motion

Lie on your back and bend your knees, so your feet are together and flat on the floor. Slowly lower your knees out to the sides. Rest your hands on the inside of your knees and gently push down to deepen the stretch.

Dr Thomas Naylor is an orthopaedic surgeon and sports scientist

As told to Emily Craig

https://www.telegraph.co.uk/health-fitness/conditions/bones-joints/orthopaedic-dr-best-exercise-routine-to-treat-arthritis/

In a Heartbeat: Don’t get stiffed by arthritis

From triblive.com

Dealing with osteoarthritis can feel like one of the more debilitating points of the aging process, but it doesn’t have to lock up your life.

One in 5 adults live with chronic pain and nearly half of adults over 40 experience joint problems each year, according to Dr. Christine Peoples, director of UPMC’s Telerheumatology Program and clinical associate professor of medicine at the University of Pittsburgh. The back, hips, knees and feet are the most common areas affected.

Peoples offered up a number of helpful tips on how to recognize and deal with the condition.

Q: When should I see a doctor about joint pain? How much is normal aging?

A: While some aches and pains can happen with aging, joint pain should not always be considered a normal part of getting older. Certain symptoms may be a sign of a more serious condition and should be evaluated by a doctor.

You should see a doctor if your joint pain does not improve with rest or over-the-counter medicines such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin); a joint becomes swollen, red, or warm; pain wakes you up during the night; joint pain makes it difficult to walk or perform everyday activities, such as bathing or getting dressed; you notice a sudden change in your joint pain or symptoms.

Getting medical care early can help find the cause of your joint pain and start the right treatment before the problem gets worse.

Q: What age can arthritis set in?

A: Osteoarthritis becomes more common as we get older. It is uncommon for people under age 30 to have significant symptoms, but about one in three adults over age 75 are affected. Most people are diagnosed around age 55, although symptoms can begin in the late 40s or early 50s.

Some people develop osteoarthritis at a younger age. Risk factors include being overweight, a previous joint injury, physically demanding jobs, certain sports, joint shape differences, and a family history of arthritis.

The good news is that regular, moderate exercise — such as walking, cycling or swimming — does not increase the risk of osteoarthritis. In fact, staying active helps keep joints healthy, reduces pain and stiffness and improves strength and mobility.

Q: How much of osteoarthritis is genetic?

A: Experts estimate that genetics account for about 40% to 80% of a person’s risk. Rare genetic conditions can cause osteoarthritis to develop at a young age, sometimes during the teen years or 20s, but these cases are uncommon.

Q: How many different types of arthritis are there and how do some of the most common varieties differ?

A: Arthritis is not a single disease — it is a term used to describe joint pain, swelling and/or stiffness. There are more than 100 types of arthritis and arthritis-associated conditions, and each has different causes and treatments.

Osteoarthritis is the most common type. It usually develops with age and causes pain that gets worse with activity and improves with rest. It most often affects the knees, hips, hands and spine. Unlike some forms of inflammatory arthritis, it is not an autoimmune disease. 

Rheumatoid arthritis is an autoimmune disease in which the immune system attacks the joints. It often causes pain, swelling and stiffness in the same joints on both sides of the body, especially the hands, wrists and feet. Morning stiffness lasting longer than 30 to 60 minutes is common, and fatigue is also a frequent symptom.

Gout is caused by uric acid crystals in a joint. It usually causes sudden, severe pain, swelling, redness and warmth, often affecting the big toe (more so in men than women). Attacks often begin at night and require medical treatment.

Other forms include psoriatic arthritis, ankylosing spondylitis, lupus-related arthritis, reactive arthritis and juvenile idiopathic arthritis.

Some conditions, such as fibromyalgia, can cause widespread pain and stiffness, but fibromyalgia is not a form of arthritis because it does not cause joint inflammation or damage.

Q: Are there tell-tale signs that it’s arthritis and not a symptom of another condition?

A: All joint pain is not arthritis.

Viral or bacterial infections can cause temporary joint and muscle pain.

Pay attention to your symptoms as a whole. If your joint pain is accompanied by a rash, fever, hair loss, trouble swallowing, abdominal pain or other unexplained symptoms, it could be a sign of a condition other than arthritis.

Q: What can be done about osteoarthritis once it sets in?

A: While osteoarthritis cannot be cured, there are many ways to reduce pain, improve movement and help slow its progression.

Regular physical activity is the foundation of treatment. Walking, cycling, swimming, strength training and other low-impact exercises help strengthen the muscles around your joints, improve flexibility and reduce pain. If you need help getting started, ask your doctor if physical therapy is right for you.

Maintaining a healthy weight is another important step. Even losing 5% to 10% of your body weight can reduce stress on your joints and improve knee and hip pain.

Assistive devices, such as a cane, walker, or knee brace, can improve balance and make daily activities easier.

Q: Are there any new treatment options?

A: Research has led to new treatment options and even more are being studied.

For some people, injections such as extended-release corticosteroids (for knee osteoarthritis), hyaluronic acid, or platelet-rich plasma (PRP) may help reduce pain. However, these treatments do not work for everyone, and the evidence supporting some of them — especially PRP — is still evolving.

Advances in joint replacement surgery, including improved implants and robotic-assisted techniques, have also helped many people recover more quickly and return to their daily activities.

Researchers are also studying new treatments that may help protect cartilage, reduce inflammation or slow the progression of osteoarthritis. These include medications such as GLP-1 drugs, biologic therapies and stem cell treatments, but more research is needed before many of these approaches become routine.

Q: Any tips for managing persistent joint pain symptoms?

A: Stay active. Find what works for you, whether it’s joining a gym, walking outdoors, or exercising at home; the best exercise program is one you can stick with.

Eat a healthy diet. Focus on fruits, vegetables, whole grains, lean proteins and healthy fats.

Depending on your symptoms, medications such as acetaminophen, anti-inflammatory medicines, duloxetine or joint injections may help reduce pain and improve function. Avoid opioid pain medications whenever possible. For most people with osteoarthritis, the risks outweigh the benefits. 

Be cautious with supplements. Products such as glucosamine and chondroitin have not consistently been shown to improve osteoarthritis symptoms, so they are not routinely recommended.

Q: What are some ways to decrease stiffness when sitting for long periods of time?

A: When joints stay in one position for too long, they can become stiff — a phenomenon often called “gelling.” The good news is that the stiffness usually improves once you start moving.

Here are a few simple ways to reduce stiffness: Move every 20 to 30 minutes. Stand up, stretch or take a short walk whenever possible. Keep moving during travel with simple seated exercises such as ankle pumps, knee bends and gentle ankle circles. Stretch regularly. Gentle stretches for your legs, hips, hands and fingers can help improve flexibility and reduce stiffness. Use heat if it helps. A heating pad or warm compress before getting up may make it easier to move. Make your chair more comfortable. A supportive cushion or a rolled towel behind your lower back can improve comfort and make standing easier.

Q: What kind of diet should I take up?

A: Healthy eating can help reduce inflammation, support overall health and make it easier to maintain a healthy weight — one of the best ways to protect your joints. I encourage my patients to think about a healthy way of eating. The Mediterranean-style eating pattern is one of the healthiest choices. It emphasizes fruits, vegetables, whole grains, beans, nuts, olive oil and fish.

Try to limit processed foods, sugary drinks, sweets, refined grains (such as white bread and white rice), processed meats and excessive alcohol.

https://triblive.com/news/health-now/in-a-heartbeat-dont-get-stiffed-by-arthritis/

Air pollution linked to spikes in rheumatoid arthritis activity and flare risk

From medicalxpress.com

A study shows that exposure to air pollution, especially fine particulate matter like dust, soot and smoke (PM2.5), is associated with increased disease activity and flare risk in rheumatoid arthritis (RA).

The findings from an article in the journal Annals of the Rheumatic Diseases (ARD) underscore the importance of health care providers and policymakers recognizing its impact on RA management.

RA is a chronic autoimmune disease characterized by joint inflammation and damage, and widespread systemic symptoms can affect other parts of the body beyond the joints. Globally, it affects about 0.5% to 1% of the adult population. Many factors contribute to the development of RA, such as genetics, immune system changes and environmental exposures. These environmental factors may play a critical role in both the onset and exacerbation of RA; importantly, many are modifiable. Smoking is one of the well-established risk factors, while climatic factors, such as air temperature and humidity, and certain pollutants, like silica, have also been implicated.

Previous epidemiological studies have shown an association between air pollution and an increased risk of developing RA. A team of investigators in South Korea conducted research to evaluate the effects of air pollution on disease activity and flare occurrence in patients with established RA and explore its underlying mechanisms.

Credit: Sun Hwan Shim

Editorial sees broad implications

In an accompanying editorial, Jeffrey A. Sparks, M.D., M.M.Sc., of the Division of Rheumatology, Inflammation, and Immunity at Mass General Brigham / Brigham and Women's Hospital and Harvard Medical School, comments, "This is one of the largest studies to use robust methods to link air pollutants with RA disease activity. Considering rising levels of air pollutants, these results have significant clinical, biological and public health implications."

"They also further reinforce that inhalants may have broad implications for risk and progression of RA and perhaps other autoimmune diseases. From a clinical perspective, this may offer avenues to lower the risk of RA flares by avoiding poor-quality air and provide some potential explanation for otherwise idiosyncratic RA flares."

Tracking pollution against clinic visits

This prospective cohort study tracked 1,070 patients with RA across 12,583 real-world outpatient visits over four years (2021–2024) at a major South Korean medical centre. Air pollution exposure was estimated using monthly concentrations of six major air pollutants (sulphur dioxide, SO2; nitrogen dioxide, NO2; ozone, O3; carbon monoxide, CO; particulate matter with a diameter of 10 µm, PM10; and particulate matter with a diameter of 2.5 µm, PM2.5), which were matched with disease activity and flare outcomes longitudinally recorded at each outpatient visit.

The statistical analysis was adjusted for demographic characteristics, serologic status (the presence of specific antibodies typical for RA in the blood), medication use, socioeconomic factors and meteorological variables. For a sensitivity analysis to better control for time-invariant confounding and avoid potential reverse causation inherent in the monthly analysis, investigators applied a case-crossover design using daily air pollutant concentrations preceding each visit. They used conditional logistic regression to assess changes within the same patient.

Fine particles stood out

"Our study found that higher PM2.5 concentrations were associated with increased disease activity and flare risk, particularly with prolonged exposure to elevated PM2.5 over more than two weeks," explains lead investigator Eun Bong Lee, M.D., Ph.D., of the Division of Rheumatology, Department of Internal Medicine, Seoul National University College of Medicine, and Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea.

The investigators identified PM2.5 as the key contributor to increased RA disease activity. Because these microscopic particles are smaller than red blood cells, they can easily travel from the lungs into the bloodstream, circulating to distant organs. They can then trigger the overproduction of harmful molecules called reactive oxygen species, thereby inducing cellular stress, damaging DNA and sparking inflammatory responses in organs.

Questions beyond one population

Lee concludes, "Our study has important implications for public health policymaking. While further studies are warranted to determine whether improving air quality can reduce disease activity in RA patients, we recommend that these patients avoid prolonged exposure to poor air quality, particularly high PM2.5 levels."

ARD Editor-in-Chief Josef Smolen, M.D., of the Medical University of Vienna, adds, "As always, this paper underwent thorough peer review, and it was nice to learn that all reviewers agreed on the importance and interest of these findings. Nevertheless, we should be aware that the observations pertain to the studied Korean population, with a specific genetic background and under specific environmental circumstances.

Whether these data hold true in other regions of the world should be a focus of future investigations. However, it is an excellent starting point for our better understanding of factors that may play a role in influencing disease activity and therapeutic responses of patients with RA. And it is an important wake-up call. The environment is likely an essential contributor to pain and inflammation in the patients for whom we care."

https://medicalxpress.com/news/2026-08-air-pollution-linked-spikes-rheumatoid.html#google_vignette