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In the present study, we aim to systematically appraise the epidemiological credibility of the environmental risk factors for rheumatic diseases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We systematically searched PubMed to capture meta\u2010analyses of observational studies on environmental risk factors for the most prevalent rheumatic diseases. For each association, we estimated the summary effect size estimate, the 95% confidence and prediction intervals, and the <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup> metric. We further examined the presence of small\u2010study effects and excess significance bias.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Overall, we identified 30 eligible papers describing 42 associations. Thirty\u2010three associations were statistically significant at <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.05, whereas 13 of them were statistically significant at <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a01\u00a0\u00d7\u00a010<jats:sup>\u22126<\/jats:sup>. Thirty\u2010two associations had large or very large between\u2010study heterogeneity. In 12 associations, evidence of small\u2010study effects and\/or excess significance bias was found. Six risk factors (nine associations) presented convincing or highly suggestive evidence of association: smoking and pack\u2010years of smoking for rheumatoid arthritis; <jats:styled-content style=\"fixed-case\">BMI<\/jats:styled-content> (per 5\u00a0kg\/m<jats:sup>2<\/jats:sup> increase) for gout and hip osteoarthritis; alcohol consumption for gout; <jats:styled-content style=\"fixed-case\">BMI<\/jats:styled-content> (overweight vs lean, obese vs lean), knee injury and participation in heavy work for knee osteoarthritis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our umbrella review indicated that a narrow range of risk factors has been examined for rheumatic diseases. Current evidence strongly supports that smoking, obesity, alcohol consumption, knee injury, and work activities are associated with risk for at least one rheumatic disease.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1756-185x.13356","type":"journal-article","created":{"date-parts":[[2018,8,29]],"date-time":"2018-08-29T23:07:40Z","timestamp":1535584060000},"page":"1514-1524","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Elucidating the environmental risk factors for rheumatic diseases: An umbrella review of meta\u2010analyses"],"prefix":"10.1111","volume":"21","author":[{"given":"Lazaros","family":"Belbasis","sequence":"first","affiliation":[{"name":"Department of Hygiene and Epidemiology University of Ioannina Medical School Ioannina Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasilios","family":"Dosis","sequence":"additional","affiliation":[{"name":"Department of Hygiene and Epidemiology 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