Toxic air, PM2.5 pollution could be fuelling surge in rheumatoid arthritis cases in Delhi-NCR: Experts

New Delhi, Oct 9 (PTI) A new health crisis is emerging as air pollution may be silently triggering rheumatoid arthritis, one of the most debilitating autoimmune diseases worldwide, experts said on Thursday.

At the 40th annual conference of the Indian Rheumatology Association (IRACON 2025) being held from October 9-“12 at the Yashobhoomi here, leading rheumatologists cited alarming evidence that toxic air and PM2.5 pollution could be fuelling a surge in rheumatoid arthritis cases across Delhi-NCR.

Rheumatoid arthritis (RA) is a chronic autoimmune disorder in which the immune system attacks the body's own tissues, especially the joints, causing persistent pain, swelling, stiffness, and disability.

Traditionally linked to genetics and immune system dysfunction, RA is now increasingly being associated with environmental triggers such as air pollution.

Delhi, one of the top 10 most polluted cities in the world, has emerged as a hotbed of concern, the experts said.

Recent studies in Europe, China, and now in India, suggest that exposure to PM2.5, the dangerous fine particulate matter that penetrates deep into the lungs,” may be linked not only to heart and lung diseases, but also to autoimmune disorders like RA.

Expressing deep concern, Dr Uma Kumar, Head of Rheumatology at AIIMS Delhi, said, "We are observing a rise in RA cases in patients living in polluted areas with no family history or genetic predisposition to autoimmune disease. Pollutants induce inflammatory reactions, exacerbating joint damage and promoting disease progression." These toxins trigger systemic inflammation and oxidative stress, causing an overactive immune response.

"It is a public health emergency we can no longer ignore," Kumar said.

Adding to the urgency, Dr Bimlesh Dhar Pandey from Fortis Hospital, Noida, said pollution is linked to arthritis, particularly rheumatoid arthritis, as air pollutants can cause inflammation, oxidative stress, and autoantibody production.

"Studies show strong associations between exposure to PM2.5, nitrogen oxides, and ozone with increased risk of RA and worsening symptoms, especially in genetically susceptible individuals. Living near busy roads, which means constant traffic-related pollution, has also been linked to higher RA risk," Pandey said.

The findings are not just theoretical. A landmark study published in the European Medical Journal (2025) provided strong genetic evidence connecting air pollution to autoimmune diseases, including RA.

Using a "two-sample Mendelian randomisation approach", the study identified significant causal links between common pollutants and immune system dysfunction, highlighting environmental damage as a crucial driver in the rise of these diseases.

Dr Neeraj Jain from Sir Ganga Ram Hospital warned, "We used to think of RA as mainly genetic, but pollution is rewriting that narrative. The environmental burden is tipping the scales, turning healthy individuals into patients. The fact that young people with no family history are developing RA should set the alarm bells ringing." Doctors are not just witnessing more RA cases but also more severe ones. Reduced green spaces in the urban areas are worsening the problem, depriving residents of protective environmental buffers, Dr Pulin Gupta from Dr Ram Manohar Lohia Hospital, New Delhi, said.

"This is not merely a medical issue, it is a societal crisis," Dr Rohini Handa from Indraprastha Apollo Hospitals, New Delhi, said.

The experts also pointed out that autoimmune diseases such as RA are lifelong conditions with no permanent cure available; they can only be managed.

With pollution adding fuel to the fire, the prevalence of RA is expected to rise in Delhi-NCR and similar polluted regions.

Current estimates suggest that RA already affects around 1 per cent of India's adult population, but with pollution as a trigger, these numbers may spike dramatically, the experts said.

They also stressed the urgent need for multidisciplinary actions such as stricter pollution control, increased public awareness, early screening of at-risk populations, and lifestyle changes to reduce exposure.

They also called for expansion of urban green cover, cleaner transport solutions, and stronger national policies linking air quality to health. PTI PLB SHS ARI