Workplace Air May Up Your Risk for Rheumatoid Arthritis

From healthcentral.com 

New research says exposure to certain inhalants could increase the odds of autoimmune conditions

You might not suspect that the air you breathe in could affect your joints or your immune system. But inhaling dust, fumes, and chemical vapours on the job may impact your health in ways far beyond irritating your lungs or causing respiratory issues. Breathing in bad air could also raise your risk of developing rheumatoid arthritis (RA), new research suggests.

A large research review recently published in Arthritis & Rheumatology found that people whose jobs expose them to certain occupational inhalants are at significantly higher risk of developing RA compared to people who aren’t regularly exposed. This new study adds to the growing pile of evidence that inhaling certain substances into the lungs—including silica, asbestos, solvents, pesticides, animal dust, and engine exhaust—may play a key role in triggering RA and other autoimmune diseases.

An Emerging Picture of RA Risk

Scientists don’t fully understand why only some people develop RA, an autoimmune disease in which the immune system attacks the body’s own joints—leading to inflammation, pain, stiffness, and joint damage over time. They do know it involves a combination of genetic, environmental, and lifestyle risk factors, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMSD).

One known risk factor for RA is smoking, according to NIAMSD. This suggests a lung-joint connection that has led researchers to investigate whether breathing in other kinds of harmful particles could also help trigger RA. “There are theories that things we inhale, either work-related or pollution-related, or with smoking cigarettes, may prompt an immune reaction,” says Julianna Desmarais, M.D., an associate professor of medicine in the division of arthritis and rheumatic diseases at the Oregon Health & Science University School of Medicine in Portland, OR.

Some studies have previously suggested a link between RA and breathing in certain types of dust and chemicals—with the most evidence for silica, commonly released into the air in industries like construction and mining. But the results haven’t been conclusive. For this paper, researchers wanted to evaluate the existing body of evidence on a variety of workplace inhalants to get a clear picture of whether they are truly a significant environmental risk factor for RA.

A Clear Signal in the Data

“Our study pulled together decades of global research,” says genetic epidemiologist and study co-author Xia Jiang, Ph.D, an assistant professor in the department of clinical neuroscience at the Karolinska Institute in Stockholm, Sweden, and full professor of epidemiology at the West China School of Public Health at Sichuan University in Chengdu.

The team systematically reviewed 31 studies in total and analysed data pooled from 25 different studies to look at how being exposed to 10 different types of chemicals impacted RA risk. Some of the studies were cohorts (meaning they followed people over time to see who developed RA), while others were case-control studies (comparing inhalant exposures among people with and without RA). The authors also accounted for other known risk factors, like smoking and age.

The results were clear. The review “found strong evidence that breathing in certain dusts and chemicals at work increases a person’s risk of developing rheumatoid arthritis,” says Dr. Jiang.

For seven of the 10 inhalants researchers looked at, there was a significant effect—increasing somebody’s risk of RA anywhere from 20% to 49%, depending on the substance:

• Fertilizer: 49% higher risk

• Engine exhaust: 45% higher risk

• Asbestos: 39% higher risk

• Silica: 36% higher risk

• Pesticides: 32% higher risk

• Solvents: 24% higher risk

• Animal dust: 20% higher risk

For many of these agents, there appeared to be a dose effect—meaning that a longer duration or higher intensity of exposure correlated with a greater increase in RA risk. (But the authors note that exposure measurement varied widely across studies).

What surprised the researchers was the variety of inhalants linked to RA. “We expected silica and asbestos to show an effect,” Dr. Jiang says, but “the strength of the connection for some less-studied exposures was striking.” This means that working in industries we might not traditionally think of as particularly dusty or high-risk—like farming and transportation—may increase RA risk, Dr. Jiang explains.

The researchers also identified 25 other inhalants that were associated with an increased risk for RA (such as fungicides, carbon monoxide, welding fumes, and pulp or paper dust). But there weren’t enough studies to include these substances in the analysis.

                                                                                            GettyImages/skynesher

How Inhalants Might Trigger RA

How could what’s going on in your lungs end up affecting your joints? Scientists think that the lungs may act as a sort of gateway where autoimmune disease begins. “The lung interacts with the outside world in a unique way,” Dr. Desmarais says. Inflammatory dusts and vapours “may lead to an immune reaction that starts in the lungs, but later causes symptoms elsewhere, such as the joints,” Dr. Desmarais says.

“It’s a case of the immune system ‘misfiring’ after being repeatedly triggered in the airways,” Dr. Jiang elaborates. “When you inhale irritating particles, they can cause mild, ongoing inflammation in the lung. In some people, this may confuse the immune system, causing it to attack the body’s own tissues—like the joints—instead of just dealing with the dust.” This may be more likely to happen in people who are already genetically predisposed to RA, Dr. Desmarais adds.

There’s a decent chance that this same process could play a role in other autoimmune diseases. “We already know that smoking is a risk factor for lupus, multiple sclerosis, myositis, and scleroderma,” Dr. Jiang points out. “If inhaled substances can disrupt immune regulation and trigger one autoimmune disease like RA…[they] may provide risk also for these other autoimmune diseases.”

Looking Ahead

Experts would like to see more research into what “dose” of exposure seems to trigger immune responses that lead to RA or other autoimmune diseases. “We need to understand how much and how long exposure is needed to increase risk. Is there a threshold?” says Dr. Jiang. Another big question is how breathing in more than one of these substances could impact RA risk, Dr. Desmarais says, given that people often encounter several dusts or chemicals at once in their workplace.

Researchers also hope to learn how different populations might be affected differently. Future studies could look into whether this exposure threshold varies based on the age or ethnicity of the patient, Dr. Desmarais says—as well as sex, adds Dr. Jiang. “And we need to know how [inhalant exposure] interacts with genetics and lifestyle factors, like smoking,” Dr. Jiang says.

Ultimately, the research into the effects of workplace inhalants will likely expand beyond rheumatoid arthritis—and potentially help answer bigger questions about autoimmunity. “The exposures that we found to be risk factors for RA should also be investigated in other autoimmune diseases,” Dr. Jiang says. And if that turns out to be the case, “workplace air quality might be a broader health concern than previously recognized,” Dr. Jiang says.

https://www.healthcentral.com/news/rheumatoid-arthritis/workplace-air-and-rheumatoid-arthritis-risk

Inhaling fumes, dust in workplace may increase rheumatoid arthritis risk: study

From thehill.com

Inhaling certain workplace dusts and fumes may heighten the risk of developing rheumatoid arthritis, a new study has found.

Breathing in such particles — from agents such as vapours, gases and solvents — may also exacerbate the impacts of smoking and genetic susceptibility to the autoimmune disease, according to the study, published in the Annals of Rheumatic Diseases.

“Our study shows that inhalable, mainly occupational exposures act as important environmental risk factors in [rheumatoid arthritis] development,” wrote the authors, a team of medical researchers from Sweden’s Karolinska Institute.

Rheumatoid arthritis, a chronic joint disorder characterized by painful inflammation, affects up to 1 percent of the global population, the study authors noted.

While scientists are already aware that smoking heightens the risk of developing the disorder, the Karolinska team sought to determine whether breathing in workplace dust and fumes could also have an impact.

To draw their conclusions, the researchers made use of data available through the Swedish Epidemiological Investigation of Rheumatoid Arthritis.

The database includes 4,033 people newly diagnosed with the disease between 1996 and 2017, along with 6,485 individuals matched for age and sex but free of the disease.

Each participant also received a score based on whether they carried genes that could raise their risk of developing the disease, according to the study.

The type of rheumatoid arthritis diagnosis a patient receives is characterized by the presence or absence of a specific type of antibodies — with positivity for these antibodies indicating a worse prognosis, the authors explained.

Patients can still have the disorder while testing negative for these antibodies. But about 60 to 80 percent of those with rheumatoid arthritis do test positive for the antibodies, according to the Arthritis Foundation. 

In the Swedish study, patients who tested positive for the antibodies veered slightly younger, tended to be women and were more likely to smoke than those who tested negative.

About 73 percent of those who tested positive for the antibodies were exposed to workplace contaminants, while 72 percent of those who tested negative and 67 percent of control subjects were also exposed.

The researchers found that exposure to any workplace agent was linked to a 25 percent increased risk of developing antibody-positive rheumatoid arthritis. That risk surged to 40 percent in men, according to the study.

Among the agents most strongly associated with that increased risk were quartz, asbestos, diesel fumes, gasoline fumes, carbon monoxide and fungicide, the authors determined.

Only a few agents — quartz, asbestos and detergents — had strong connections to the development of antibody-negative rheumatoid arthritis, per the study.

Stressing that their research was observational only, the authors acknowledged that they could not establish cause for their findings.

However, they called for “extended measures to reduce these exposures as part of international collaborative efforts to reduce morbidities due to working life.”

In an accompanying editorial, two researchers not involved with the study likewise emphasized the need for greater public health efforts to curb the risk of developing this disease.

“First, environmental health initiatives should reduce public exposure to ambient pollutants, including carbon monoxide and gasoline exhaust,” wrote Jeffrey Sparks of Brigham and Women’s Hospital in Boston and Vanessa Kronzer of the Mayo Clinic.

“Second, occupational health initiatives should mitigate occupational hazards, including detergents and asbestos,” the doctors continued.

“Third, public health initiatives should continue to reduce cigarette smoking,” they added.

https://thehill.com/policy/equilibrium-sustainability/3764171-inhaling-fumes-dust-in-workplace-may-increase-rheumatoid-arthritis-risk-study/

Workplace Tips for Relieving Arthritis Pain

From healthline.com

Going to work with arthritis

A job primarily provides financial independence and can be a source of pride. However, if you have arthritis, your job may become more difficult due to joint pain.

The office

Sitting in a chair for a good portion of the day might seem good for someone with arthritis. But regular movement is ideal for keeping joints limber and mobile. So, sitting for long periods is counterproductive to arthritis treatments.

Here are some tips for being as pain-free as possible:

• Sit up straight. Sitting up straight keeps the spine aligned properly, prevents lower back pain, and keeps your neck from straining.
• Position your keyboard correctly. The farther away your keyboard is, the more you must lean in to reach it. That means adding unnecessary strain on your neck, shoulders, and arms. Keep your keyboard at a comfortable distance so your arms can rest easily on your desk while you sit up straight.
• Use ergonomic devices: An orthopaedic chair, a keyboard rest, or even a small pillow can help you feel more comfortable.
• Get up and walk around. Getting up from time to time is a good way to incorporate some movement into your day.
• Move while sitting. Simply extending your legs occasionally is good for your arthritis. It can prevent your knees from stiffening.

On your feet

Working the coffee counter, the line in a kitchen, or anywhere else you stand for long periods requires repetitive movements that can be just as damaging to joints as inactivity.

Activity is important for people with arthritis. But getting relief from pain when standing a lot may be difficult.

Here are some tips to keep movement to a minimum when you’re standing all day:

• Stay organized. Keep what you need closest to you. These items include tools, paperwork, and electronic devices. While movement is important, unnecessary stretching and pulling can tire you out more quickly.
• Lift smart. Improper lifting is a common way to cause injury. People with arthritis need to be especially careful when lifting because of the deterioration of joints and inflammation caused by arthritis. Ask for help or use a back brace to prevent injury to muscles and joints.
• Move. Standing in one position all day can increase stiffness. Bend your knees occasionally if you stand all day. Stooping down for a second gives the knees a chance to release built-up pressure caused by standing all day.

Break time

It doesn’t matter if you’re working a 6-hour or a 12-hour shift, break time is important. It can be both a mental break and great opportunity to recharge physically.

Whether you sit or stand all day, it’s important to take a few minutes to do the following during break time:

• Stretch. One easy rule is, if it hurts, move it. If your knees hurt, take some time to stretch them out, even if it’s as simple as trying to touch your toes. Slowly roll your head around to loosen your neck muscles. Make a tight fist, then stretch out your fingers to get blood flowing to the joints in your hands.
• Walk. Going for a quick walk around the block or to a local park gets you moving. And being outdoors can help relieve unwanted stress.
• Water. Drink plenty of water to keep your body hydrated.
• Sit if you need to. Arthritis requires a fine balance of movement and rest. You don’t want to overdo it, so give your joints a rest occasionally. You may need more rest when inflammation occurs, but don’t let it get to the point where movement is difficult because you’ve rested too long.

Talk to your boss

Tell your employer about your arthritis. Help them understand that you may need extra time to do certain tasks, or that you might not be able to do any heavy lifting.

The best course of action is to get a letter from your doctor and present it to your boss or someone in your human resources department. This ensures the people you work with are aware of your arthritis.

Informing your employer can help you obtain necessary accommodations, like reassignment to a position that doesn’t require standing all day, or access to assistive devices that help make your job easier. It also helps protect you against unlawful termination.

Know your rights

The Americans with Disabilities Act (ADA) is the most extensive legal measure to protect employees with disabilities. It applies to companies with more than 15 employees. It covers discrimination in hiring and employing of people with disabilities. To be considered disabled, your arthritis must “substantially limit” major life activities such as walking or working.

Under the law, employers are required to give employees “reasonable accommodations,” including:

• part-time or adjusted work schedules
• job restructuring, such as eliminating nonessential tasks
• providing assistive devices or equipment
• making the workplace more accessible, like altering the height of a desk

However, some accommodations that cause your employer “significant difficulty or expense” may not be covered under the law. You have the option of providing it yourself or sharing the expenses with your employer.

You can get more information about the ADA and other applicable laws from your human resources department.

https://www.healthline.com/health/osteoarthritis/workplace#in-an-office