Environmental exposures in autoimmune inflammatory rheumatic diseases: a priority-based evidence map, immune-mechanism integration audit and research agenda
Abstract
Introduction: Environmental exposures have been hypothesised to influence immune tolerance, but human studies of autoimmune inflammatory rheumatic diseases (AIRDs) often report exposure-disease associations without measuring immune intermediates. We mapped the structure, directionality, immune-mechanism integration and research priorities of this literature.
Methods: Web of Science Core Collection and Scopus were searched on 18 May 2026 for English-language article/review records published during 2005-2025; non-original publications were excluded during eligibility assessment. Of 12,497 deduplicated records screened at title/abstract level, a predefined prioritisation strategy selected 2,632 reports for focused coding. Four high-density exposure-AIRD cells underwent SWiM-aligned direction-of-effect synthesis and focused OHAT-style risk-of-bias assessment, 64 cells underwent consensus research-priority scoring, and a post hoc four-level audit assessed immune-mechanism integration. No pooled effect estimates were calculated because exposures, outcomes, designs and analytical approaches were heterogeneous.
Results: Of 17,089 records before deduplication, 433 studies were included. Smoking/tobacco exposures dominated (n = 215, 49.7%), and rheumatoid arthritis was the most studied AIRD (n = 254, 58.7%). Twenty-five studies (5.8%) directly measured a pathway-proximal intermediary or omics readout, 79 (18.2%) measured an immune, serologic, complement or inflammatory biomarker, and…
How strong is the evidence?
Evidence Hub reads this as a systematic review, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 254 participants or records.
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