Seasonal variations of systemic lupus erythematosus flares in southern France.

OBJECTIVE: Exposure to sunlight is one of the environmental factors involved in the pathogenesis of systemic lupus erythematosus. We investigated whether there is seasonal variation in the incidence of cutaneous and noncutaneous severe lupus flares in southern France. METHODS: We retrospectively reviewed clinical and biological data from all SLE patients hospitalized for a flare of the disease during a two year period in our centre and collected corresponding meteorological data from the official website of MeteoFrance. RESULTS: Forty one patients, mean age 36.7 ± 13.8 years, were included. Twenty-six patients (63.4%) had kidney biopsy performed, showing in all cases proliferative nephritis, associated with membranous nephritis in 9 (22%). We found a clear seasonal pattern for overall lupus flares with 39% of flares occurred in Spring. Among patients without any cutaneous involvement, this seasonal pattern was still observed (p=0.024). Patients under antimalarials presented flares significantly later in the sunny season than those without (respectively median in July versus May, p=0.044). There were strong positive correlations between occurrence of lupus flares and maximum temperature increase (ρ=0.87, p<0.001), minimum temperature increase (ρ=0.87, p<0.001), and duration of sunshine increase (ρ=0.78, p=0.003). These correlations were also observed in patients with renal flares. CONCLUSION: We confirmed a seasonal pattern for lupus flares among patients living in Southern France, with most flares in spring, in correlation with an increase in temperature and duration of sunshine. A similar seasonal pattern was observed in patients with no cutaneous involvement and with visceral involvement.

Mathematical modelling of the impact of climatic conditions in France on Rhipicephalus sanguineus tick activity and density since 1960.

Rhipicephalus sanguineus, the brown dog tick, has a worldwide distribution in areas with a relatively warm climate, including mild winters. This tick plays an important role as vector for various animal and human pathogens, including bacteria and protozoa. Based on precise daily meteorological data from the past 40 years, combined with mathematical modelling designed to predict tick activity, two modelling approaches were developed. The first examined the evolution of the number of weeks with favourable biological conditions for ticks in four French cities located at various latitudes of the country: Nîmes in the south, Paris in the north, Lyon in the east and Nantes in the west. The second analysed the extension of the geographical surface area in km(2) where the biological conditions favour tick activity for at least 12 weeks per year. Both analyses revealed clear evidence of increased temperatures coupled with an augmented tick activity index in three of the four cities. However, the change was not significant in Nîmes, where the climate is Mediterranean and the tick is already endemic. For Paris, Lyon and Nantes, the activity index values have increased significantly, i.e. by 4.4%, 4.0% and 3.4%, respectively. The distribution of the activity index values is evolving strongly with significantly fewer values below 50% since the 1960s and a clear decrease of values between 20% and 50% during the latest decade. Between 1960 and 2000, the theoretical extension of the surface area where the climatic index is suitable for R. sanguineus has increased by 66%. Even though several other important factors, such as changes in biotopes or human activity, are not included in this study, the resulting patterns and trends are noticeable. Our models constitute the first demonstration of the impact of climate change on the activity and distribution of ticks and confirm the observed northward migration trend for this Mediterranean domestic tick.