Environmental Health, Occupational Health, Environmental Justice, and Climate Change
New methodology to determine potential environmental triggers for ANCA-associated vasculitides
Kaley Beins (School of Public Health (UMD) MIAEH Master's Student)
Kaley, Beins (UMD SPH Maryland Institute of Applied Environmental Health), Milton, Don (UMD SPH Maryland Institute of Applied Environmental Health)

Background: Vasculitis is an umbrella category covering a series of about 20 rare autoimmune disorders. Anti-neutrophil cytoplasmic antibody (ANCA)- associated vasculitis comprise three diagnostic forms of this autoimmune disorder: granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome). Due to the severity of these disorders, the limited resources available to vasculitis researchers have mostly been targeted towards treatment and relapse prediction with a small amount of research examining genetic and environmental etiologic factors.

Goal: This research aims to develop novel methodology that can be used to examine potential environmental triggers of vasculitis in genetically pre-disposed individuals.

Objectives: In this project the authors: 1) review the existing literature on AAV etiology to identify gaps and promising areas for future research and 2) design a novel matched case-control study on gene-environment interaction in AAV pathogenesis.

Approach: Through collaborations with medical professionals, conversations with patients, and a review of AAV literature, the authors selected specific environmental exposures to be evaluated via a series of previously validated survey questions. These environmental exposures included potential triggers from occupational, travel, and leisure activities.

Results: This research is ongoing, and the authors plan to implement this validated methodology in a full study beginning in August 2018. Currently, two rheumatologists with access to AAV patients have shown interest in supporting the study and assisting with recruitment. Additionally, approximately 200 vasculitis patients have expressed interest in the study via Facebook support group message boards, demonstrating the significance of etiologic information to the vasculitis community.

Importance to public health: Given its chronic and potentially fatal nature, AAV has high social and economic costs; however, as a result of the unknown etiology of AAV, preventative care is often impossible. Studying the environmental etiology of AAV enables physicians to be proactive in identifying risk factors, which leads to increased monitoring and the potential for reducing AAV incidence.