Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.


Is air pollution linked with poor response to biologics?

Limited data suggest associations between air pollution and rheumatic disease risk and outcomes. More sophisticated research is needed to clarify the conditions under which air pollution might influence the health of people with rheumatic disease, including their response to biologic drugs.

Your institute does not have access to this article

Access options

Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.


  1. Bernatsky, S. et al. Associations between ambient fine particulate levels and disease activity in patients with systemic lupus erythematosus (SLE). Environ. Health Perspect. 119, 45–49 (2011).

    CAS  Article  Google Scholar 

  2. Stojan, G. et al. A spatial-temporal analysis of organ-specific lupus flares in relation to atmospheric variables and fine particulate matter pollution. Arthritis Rheumatol. 72, 1134–1142 (2020).

    CAS  Article  Google Scholar 

  3. Chang, K. H. et al. Air pollution exposure increases the risk of rheumatoid arthritis: A longitudinal and nationwide study. Environ. Int. 94, 495–499 (2016).

    CAS  Article  Google Scholar 

  4. Adami, G. et al. Association between environmental air pollution and rheumatoid arthritis flares. Rheumatology (2021).

    Article  PubMed  Google Scholar 

  5. Adami, G. et al. Environmental air pollution is a predictor of poor response to biological drugs in chronic inflammatory arthritides. ACR Open Rheumatol. (2021).

    Article  PubMed  PubMed Central  Google Scholar 

  6. Hammer, M. S. et al. Global estimates and long-term trends of fine particulate matter concentrations (1998-2018). Environ. Sci. Technol. 54, 7879–7890 (2020).

    CAS  Article  Google Scholar 

  7. De Roos, A. J. et al. Proximity to traffic, ambient air pollution, and community noise in relation to incident rheumatoid arthritis. Environ. Health Perspect. 122, 1075–1080 (2014).

    Article  Google Scholar 

  8. Bobb, J. F. et al. Bayesian kernel machine regression for estimating the health effects of multi-pollutant mixtures. Biostatistics 16, 493–508 (2015).

    Article  Google Scholar 

  9. Keil, A. P. et al. A quantile-based g-computation approach to addressing the effects of exposure mixtures. Environ. Health Perspect. 128, 47004 (2020).

    Article  Google Scholar 

  10. Zhao, N. et al. Long-term exposure to a mixture of industrial SO2, NO2, and PM2.5 and anti-citrullinated protein antibody positivity. Environ. Health 19, 86 (2020).

    CAS  Article  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Sasha Bernatsky.

Ethics declarations

Competing interests

The authors declare no competing interests.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Zhao, N., Bernatsky, S. Is air pollution linked with poor response to biologics?. Nat Rev Rheumatol 17, 583–584 (2021).

Download citation

  • Published:

  • Issue Date:

  • DOI:


Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing