{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T16:31:40Z","timestamp":1787329900461,"version":"build-2736575974"},"reference-count":23,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2021,2,3]],"date-time":"2021-02-03T00:00:00Z","timestamp":1612310400000},"content-version":"am","delay-in-days":277,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#am"},{"start":{"date-parts":[[2020,5,2]],"date-time":"2020-05-02T00:00:00Z","timestamp":1588377600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000005","name":"U.S. Department of Defense","doi-asserted-by":"publisher","award":["W81XWH19\u20101\u20100793"],"award-info":[{"award-number":["W81XWH19\u20101\u20100793"]}],"id":[{"id":"10.13039\/100000005","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000069","name":"National Institute of Arthritis and Musculoskeletal and Skin Diseases","doi-asserted-by":"publisher","award":["AR43727"],"award-info":[{"award-number":["AR43727"]}],"id":[{"id":"10.13039\/100000069","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000069","name":"National Institute of Arthritis and Musculoskeletal and Skin Diseases","doi-asserted-by":"publisher","award":["AR69572"],"award-info":[{"award-number":["AR69572"]}],"id":[{"id":"10.13039\/100000069","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis &amp; Rheumatology"],"published-print":{"date-parts":[[2020,7]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To identify potential clusters of systemic lupus erythematosus (<jats:styled-content style=\"fixed-case\">SLE<\/jats:styled-content>) organ\u2010specific flares and their relationship to fine particulate matter pollution (PM2.5), temperature, ozone concentration, resultant wind, relative humidity, and barometric pressure in the Hopkins Lupus Cohort, using spatiotemporal cluster analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 1,628 patients who fulfilled the Systemic Lupus International Collaborating Clinics classification criteria for <jats:styled-content style=\"fixed-case\">SLE<\/jats:styled-content> and who had a home address recorded were included in the analysis. Disease activity was assessed using the Lupus Activity Index. Assessment of rash, joint involvement, serositis, and neurologic, pulmonary, renal, and hematologic activity was quantified on a 0\u20133 visual analog scale (<jats:styled-content style=\"fixed-case\">VAS<\/jats:styled-content>). An organ\u2010specific flare was defined as an increase in <jats:styled-content style=\"fixed-case\">VAS<\/jats:styled-content> of \u22651 point compared to the previous visit. Spatiotemporal clusters were detected using Sa<jats:styled-content style=\"fixed-case\">TS<\/jats:styled-content>can software. Regression models were used for cluster adjustment and included individual, county\u2010level, and environmental variables.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Significant clusters unadjusted for environmental variables were identified for joint flares (<jats:italic>P<\/jats:italic> &lt; 0.05; n = 3), rash flares (<jats:italic>P<\/jats:italic> &lt; 0.05; n = 4), hematologic flares (<jats:italic>P<\/jats:italic> &lt; 0.05; n = 3), neurologic flares (<jats:italic>P<\/jats:italic> &lt; 0.05; n = 2), renal flares (<jats:italic>P<\/jats:italic> &lt; 0.001; n = 4), serositis (<jats:italic>P<\/jats:italic> &lt; 0.001; n = 2), and pulmonary flares (<jats:italic>P<\/jats:italic> &lt; 0.001; n = 2). The majority of the clusters identified changed in significance, temporal extent, or spatial extent after adjustment for environmental variables.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>We describe the first spatiotemporal clusters of lupus organ\u2010specific flares. Seasonal, as well as multi\u2010year, cluster patterns were identified, differing in extent and location for the various organ\u2010specific flare types. Further studies focusing on each individual organ\u2010specific flare are needed to better understand the driving forces behind these observed changes.<\/jats:p><\/jats:sec>","DOI":"10.1002\/art.41217","type":"journal-article","created":{"date-parts":[[2020,2,3]],"date-time":"2020-02-03T21:25:00Z","timestamp":1580765100000},"page":"1134-1142","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":32,"title":["A Spatiotemporal Analysis of Organ\u2010Specific Lupus Flares in Relation to Atmospheric Variables and Fine Particulate Matter Pollution"],"prefix":"10.1002","volume":"72","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5758-5052","authenticated-orcid":false,"given":"George","family":"Stojan","sequence":"first","affiliation":[{"name":"Johns Hopkins University  Baltimore Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anton","family":"Kvit","sequence":"additional","affiliation":[{"name":"Johns Hopkins University  Baltimore Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank C.","family":"Curriero","sequence":"additional","affiliation":[{"name":"Johns Hopkins University  Baltimore Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1441-5373","authenticated-orcid":false,"given":"Michelle","family":"Petri","sequence":"additional","affiliation":[{"name":"Johns Hopkins University  Baltimore Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,5,2]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.10368"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.20049"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.22510"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2013-eular.828"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.berh.2017.09.005"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.111196"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00296-011-1971-2"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1289\/ehp.1002123"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.scitotenv.2019.03.018"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.envres.2015.12.021"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0889-857X(05)70135-6"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.34473"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780340802"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cageo.2004.03.012"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00892986"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.7172"},{"key":"e_1_2_7_18_1","doi-asserted-by":"crossref","first-page":"3808","DOI":"10.4049\/jimmunol.138.11.3808","article-title":"Interleukin 1\u2010driven secretion of interleukin 2 is highly temperature\u2010dependent","volume":"138","author":"Lederman HM","year":"1987","journal-title":"J Immunol"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/1043-4666(91)90042-C"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1038\/srep00152"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1400380111"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-immunol-031210-101405"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2011.11.004"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2014.07.064"}],"container-title":["Arthritis &amp; 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