Environmental exposures and genetic predisposition are hypothesized to interact to result in the expression of autoimmune rheumatic diseases such as rheumatoid arthritis (RA), juvenile idiopathic arthritis (JIA), and systematic autoimmune rheumatic diseases (SARDs) , as well as other immune-mediated diseases such as inflammatory bowel disease  and multiple sclerosis . Identifying modifiable risk factors for disease development and prognosis is important to reduce the substantial impact and burden of these chronic diseases in society.