{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T04:43:49Z","timestamp":1780375429036,"version":"3.54.1"},"reference-count":22,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2015,10,27]],"date-time":"2015-10-27T00:00:00Z","timestamp":1445904000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100003593","name":"Conselho Nacional de Desenvolvimento Cient\u00edfico e Tecnol\u00f3gico","doi-asserted-by":"crossref","award":["CNPQ 302724\/2011-7"],"award-info":[{"award-number":["CNPQ 302724\/2011-7"]}],"id":[{"id":"10.13039\/501100003593","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100003593","name":"Conselho Nacional de Desenvolvimento Cient\u00edfico e Tecnol\u00f3gico","doi-asserted-by":"crossref","award":["472155\/2012-1"],"award-info":[{"award-number":["472155\/2012-1"]}],"id":[{"id":"10.13039\/501100003593","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Federico Foundation"},{"name":"N\u00facleo de Apoio \u00e0 Pesquisa Sa\u00fade da Crian\u00e7a e do Adolescente da USP"},{"DOI":"10.13039\/501100001807","name":"Funda\u00e7\u00e3o de Amparo \u00e0 Pesquisa do Estado de S\u00e3o Paulo","doi-asserted-by":"crossref","award":["13\/21508-2"],"award-info":[{"award-number":["13\/21508-2"]}],"id":[{"id":"10.13039\/501100001807","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arthritis Care &amp;amp; Research"],"published-print":{"date-parts":[[2015,11]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To investigate the association between exposure to air pollutants in the Sao Paulo metropolitan area and disease activity in juvenile\u2010onset systemic lupus erythematosus (SLE) patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A longitudinal panel study based on 409 consecutive visits of juvenile\u2010onset SLE patients living in the Sao Paulo metropolitan area was carried out. Disease activity was evaluated in accordance with the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI\u20102K), and the patients were divided into 2 groups: those with SLEDAI scores \u22648 and those with SLEDAI scores &gt;8. Daily concentrations of inhaled particulate matter (PM<jats:sub>10<\/jats:sub>), sulfur dioxide, nitrogen dioxide (NO<jats:sub>2<\/jats:sub>), ozone, and carbon monoxide (CO) were evaluated on the 21 days preceding the medical visits. A generalized estimation equation model was used to assess the impact of these measurements on SLEDAI\u20102K scores, considering the fixed effects for repetitive measurements. The models were adjusted for erythrocyte sedimentation rate, corticosteroid use (daily and cumulative doses), antimalarial use, the use of immunosuppressive agents, the presence of infection 20 days preceding the medical appointment, and the minimum temperature and relative humidity outdoors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>PM<jats:sub>10<\/jats:sub>, NO<jats:sub>2<\/jats:sub>, and CO were risk factors for juvenile\u2010onset SLE disease activity (SLEDAI\u20102K score &gt;8) approximately 2 weeks after exposure. A 13.4 \u03bcg\/m<jats:sup>3<\/jats:sup> increase in the PM<jats:sub>10<\/jats:sub> moving average (from lag 12 to lag 15) was associated with a 34% increase (95% confidence interval 7.0\u201368.0) in the risk of a SLEDAI\u20102K score &gt;8.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This is the first study to show that exposure to inhaled pollutants may increase the risk of disease activity in children with juvenile\u2010onset SLE in a large urban center.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acr.22603","type":"journal-article","created":{"date-parts":[[2015,4,17]],"date-time":"2015-04-17T11:03:01Z","timestamp":1429268581000},"page":"1609-1614","source":"Crossref","is-referenced-by-count":74,"title":["Exposure to Air Pollutants and Disease Activity in Juvenile\u2010Onset Systemic Lupus Erythematosus Patients"],"prefix":"10.1002","volume":"67","author":[{"given":"Elisabeth C.","family":"Fernandes","sequence":"first","affiliation":[{"name":"Faculdade de Medicina da Universidade de S\u00e3o Paulo S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clovis A.","family":"Silva","sequence":"additional","affiliation":[{"name":"Faculdade de Medicina da Universidade de S\u00e3o Paulo S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alf\u00e9sio L. F.","family":"Braga","sequence":"additional","affiliation":[{"name":"Faculdade de Medicina da Universidade de S\u00e3o Paulo, S\u00e3o Paulo, and Universidade Catolica de Santos  Santos Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriana M. E.","family":"Sallum","sequence":"additional","affiliation":[{"name":"Faculdade de Medicina da Universidade de S\u00e3o Paulo S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L\u00facia M. A.","family":"Campos","sequence":"additional","affiliation":[{"name":"Faculdade de Medicina da Universidade de S\u00e3o Paulo S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sylvia C. L.","family":"Farhat","sequence":"additional","affiliation":[{"name":"Faculdade de Medicina da Universidade de S\u00e3o Paulo S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2015,10,27]]},"reference":[{"key":"e_1_2_3_2_1","unstructured":"World Health Organization. Air quality guidelines: global update 2005. Particulate matter ozone nitrogen dioxide and sulfur dioxide. 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