Skip to main content

Silica Exposure Risky ?


Silica Exposure Risky for Men With Scleroderma

If your patient has scleroderma, ask about silica exposure this study suggested
image
Exposure to silica is a risk factor found in more than half of one group of male patients with scleroderma and as a result, every male patient with scleroderma should be asked about silica exposure, the authors of a retrospective case-control study and systematic literature review suggested.
In a retrospective case-control study describing the clinical characteristics of patients with systemic sclerosis or scleroderma (SSc) who were exposed to silica (SSc-si) and those who were not (idiopathic SSc or SSc-id) treated at the Complexo Hospitalario Universitario de Vigo (CHUVI), Vigo, Spain between 1985 and January, 2013, investigators confirmed the diagnosis of SSc in 94 patients.
Seven of 12 males and 2 out of 81 females were selected for group 1. Group 1 consisted of patients (cases) diagnosed with SSc who had evidence of environmental exposure to silica dust.
Out of these 9 cases, 5 had worked in granite quarries, one grinding stone, another digging tunnels and the remaining two, both women, who had worked in ceramic factors.
Crystalline silica constitutes a major proportion of rocks such as marble, granite clay, and slate and also makes up a major proportion of artificial quartz compounds.
Occupational exposure occurs when individuals breathe in airborne particles that are created during various industrial activities.
The median time during which patients were exposed to silica was 25 years and the median latency period between onset of exposure and symptoms of scleroderma was 25.5 years.
Another 27 patients again treated at CHUVI were randomly selected for group 2. Group 2 served as controls where the risk of silica exposure was excluded.
The most relevant clinical differences between case series patients who had been exposed to silica vs those who had not was that men were significantly more likely to have been exposed to silica than women (P<0.001).
The diffuse variant of SSc remained more prevalent in exposed women at 50% than non-exposed women at 8% (P=0.0001) as well as in exposed men at 85.8% vs 50% for non-exposed men (P value unavailable.)
Those who had been exposed to silica were also significantly more likely to test positive for anti-Sc170 (P=0.001) and negative for anticentromere antibody (ACA) (P=0.002).
Five out of the 9 SSc-si cases were also smokers.
Almost all patients with SSc-si experienced dyspnea throughout their illness and interstitial lung disease (ILD) was present in 7 out of the 9 silica-exposed patients.
Radiological findings characteristic of silicosis were also identified in 4 patients from the same case series group.
Out to January 2013, 7 patients from group 1 (77%) died, the cause of death being respiratory failure in 2 patients, refractory heart failure in 2 cases, scleroderma renal crisis in one patient, refractory ascites due to alcoholic liver cirrhosis in another, and the cause of death in the remaining patient being unknown.
In non-exposed group of case series patients, 11 patients or 40.7% of the group died of varying causes during the same follow-up interval.
Overall, cases died well before controls at 9.2 years vs 15.1 years (P=0.023).
Investigators also went on to identify 32 articles in the literature on SSc, almost half of them being case reports.
Of the 254 patients included in these studies, 243 patients were males and onset of SSc symptoms was in the fourth and fifth decade of life.
In 6 studies, data were available for both silica-exposed SSc patients and unexposed patients and among the exposed group, males represented 37.5% to 86% of those with SSc-si and females only 0 to 2.7%.
According to the literature review, the most frequent clinical manifestation of SSc was Raynaud’s phenomenon, which occurred in 81% of reported cases while 48% of patients had digital ulcers.
“There is strong epidemiological evidence for the association between occupational exposure to crystalline silica and diseases such as silicosis, pulmonary tuberculosis, lung cancer, and chronic obstructive pulmonary disease,” Mayka Freire, MD, Complexo Hospitalario Universitario de Vigo (CHUVI), Vigo, Spain and colleagues write in the Seminars in Arthritis and Rheumatism.
“The fact that the majority of patients with SSc exposed to silica are males may be determined by the fact that males traditionally dominate these professions.”
Investigators point out that one of the limitations of their work was the small sample size of each of the evaluated studies.
“But this is almost unavoidable,” they observe, “as the SSc-si subset is very rare within a rare disease such as SSc.”
Further, most patients were diagnosed when the 1980 American College of Rheumatology preliminary classification was in use and techniques such as periungual capillaroscopy were not generally done at their own center.
It is therefore likely that they missed some cases without or with only minor skin involvement, although both the exposed and unexposed subgroups would be similarly affected, as they observed.
“As far as we know, this is the first literature review focused on recognizing clinical patterns differentiating between patients with scleroderma that were exposed and not exposed to silica,” investigators conclude.
“Multi-centre studies that can recruit a larger number of patients, especially men, to confirm diffuse cutaneous SSc and ILD prevalence or even poor prognosis in SSc-si patients, more than the hypothetical role of gender by itself, are desirable in the future.”
The authors disclosed no relationships with industry.
Reviewed by Henry A. Solomon, MD, FACP, FACC Clinical Associate Professor, Weill Cornell Medical College and Dorothy Caputo, MA, BSN, RN, Nurse Planner



------------------------------------------------------------------------------------------------------------

Prospective study to evaluate the association between systemic sclerosis and occupational exposure and review of the literature.

Marie I1, Gehanno JF, Bubenheim M, Duval-Modeste AB, Joly P, Dominique S, Bravard P, Noël D, Cailleux AF, Weber J, Lagoutte P, Benichou J, Levesque H.

CONCLUSION:

The following occupational factors have an impact in the development of SSc: crystalline silica, white spirit, aromatic solvents, chlorinated solvents, trichlorethylene, ketones and welding fumes. The risk of SSc appears to be markedly associated with high cumulative exposure. Finally, the association between SSc and occupational exposure may be variable according to gender.

http://www.ncbi.nlm.nih.gov/pubmed/24129037

-----------------------------------------------------------------------------------------------------------

Clinical peculiarities of patients with scleroderma exposed to silica: A systematic review of the literature.

Freire M1, Alonso M2, Rivera A2, Sousa A2, Soto A2, Gómez-Sousa JM2, Baroja A2, Vázquez-Triñanes C2, Sopeña B3.

CONCLUSION:

Silica exposure is a predominant risk factor in male SSc populations. The review of the literature is consistent with an association of SSc-si and diffuse scleroderma. A trend toward lower survival was observed in our series in SSc-si group.
http://www.ncbi.nlm.nih.gov/pubmed/26186806
-------------------------------------------------------------------------------------------------------------------------------------------------------------------
 2015 Mar;72(3):456-64. doi: 10.1016/j.jaad.2014.11.027. Epub 2015 Jan 10.

Association of occupational exposure with features of systemic sclerosis.

Marie I1, Menard JF2, Duval-Modeste AB3, Joly P3, Dominique S4, Bravard P5, Noël D6, Gehanno JF7, Bubenheim M8, Benichou J8, Levesque H9.

CONCLUSION:

Occupational exposure to crystalline silica/solvents is correlated with more severe forms of SSc characterized by: diffuse cutaneous involvement, interstitial lung disease, general microangiopathy (digital ulcers and myocardial dysfunction), and association with cancer.Occupational exposure should be systematically checked in all patients with SSc, as exposed patients seem to develop more severe forms of SSc.
http://www.ncbi.nlm.nih.gov/pubmed/25582539
-------------------------------------------------------------------------------------------------------------------------------------------------------------------
 2013 Feb 18;175(8):501-3.

[Silica exposure and the risk of systemic sclerosis].

[Article in Danish]
Troldborg A1, Nielsen BD, Kolstad HA, Olesen AB, Søndergaard KH.

Abstract

The aetiology of systemic sclerosis (Ssc) is unknown, but there is evidence of environmental factors playing a part in disease development in a number of cases. By examining a group of male patients with Ssc we found significant exposure to silica in 26% (6/23) of the patients compared to 2,1% in the general working population in Denmark. In the article we review the association between silica and Ssc and suggest how to question and refer patients with SSc who are suspected to have been exposed to silica.
http://www.ncbi.nlm.nih.gov/pubmed/23428266
------------------------------------------------------------------------------------------------------------
 2015 Aug;36(8):551-4. doi: 10.1016/j.revmed.2014.09.003. Epub 2014 Dec 22.

[Systemic sclerosis and occupational exposures: About a case in a driller-powderman].

[Article in French]
Boulanger M1, Bienvenu B2, Marquignon MF3, Letourneux M4, Clin B3.

Abstract

INTRODUCTION:

Erasmus' syndrome is the association between systemic sclerosis and silica exposure.

CASE REPORT:

We report a case of this syndrome in a driller-powderman exposed to silica and nitro compounds contained in explosives.

CONCLUSION:

Physiopathology and etiologies of systemic sclerosis are still not well known. However, nitric oxide, a product of nitro compounds metabolism, is involved in the physiopathology of the disease: it seems thus licit to wonder about the consequences of an uncontrolledoccupational exposure to nitric oxide on the vascular function, already damaged by systemic sclerosis. To a wider extent, our report highlights the importance of a comprehensive and detailed collection of occupational exposures for patients diagnosed with systemic sclerosis.
Copyright © 2014 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.

KEYWORDS:

Diffuse scleroderma; Dérivé nitré; Exposition professionnelle; Nitro compounds; Occupational exposure; Occupational health; Santé au travail; Sclérodermie systémique; Silica; Silice
PMID:
  
25541230
 
[PubMed - indexed for MEDLINE
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

 2014 Mar-Apr;32(2):262-6. Epub 2014 Jan 24.

Scleroderma renal crisis following silicone breast implant rupture: a case report and review of the literature.

Al Aranji G1, White D, Solanki K.

Abstract

Systemic sclerosis (SSc) is a chronic multisystem autoimmune disorder characterised by progressive functional and structural abnormalities in blood vessels leading to microvascular dysfunction, excessive production and deposition of collagen leading to the fibrosis of skin and internal organs. The aetiology of the disease is unknown. However, exposure to various environmental factors, such as polyvinyl chloride and silica have been thought to play a role in the development of the disease. For this reason, silicone breast implants have been postulated as a cause for a range of autoimmune diseases including systemic sclerosis. This remains as yet unconfirmed. We report the case of a 52-year-old woman who presented with rapid development of skin thickening followed by scleroderma renal crisis (SRC) following rupture of silicone breast implants. This is the first published case of SRC in this setting. The literature on silicone and autoimmunity is reviewed.
PMID:
  
24480575
 
[PubMed - indexed for MEDLINE]
--------------------------------------------------------------------------------------------------------------------------------------------------------------------

Systemic sclerosis and occupational risk factors: a case-control study.

Diot E1, Lesire V, Guilmot JL, Metzger MD, Pilore R, Rogier S, Stadler M, Diot P, Lemarie E, Lasfargues G.

Abstract

AIMS:

A case-control study was carried out between 1998 and 2000 to investigate the relation between systemic sclerosis and occupational exposure.

METHODS:

Eighty cases of systemic sclerosis admitted consecutively to the Department of Internal Medicine at the University Hospital of Tours from 1998 to 2000 were included. For each case, two age, gender, and smoking habits matched controls hospitalised during the same period in the same department were selected. A committee of experts was set up retrospectively to assess occupational exposure. Exposure to silica dust and organic solvents (such as trichlorethylene and other chlorinated solvents, and benzene and other aromatic solvents) was investigated using semiquantitative estimates of exposure. An exposure score was calculated for each subject based on probability, intensity, daily frequency, and duration of exposure for each period of employment. The final cumulative exposure score was obtained, taking into account all periods of employment.

RESULTS:

Significant associations with SS were observed for crystalline silica, trichlorethylene, chlorinated solvents, toluene, aromatic solvents, ketones, white spirit, epoxy resins, and welding fumes. Risk of SS was significantly associated with a high final cumulative exposure score of occupational exposure to crystalline silica, trichlorethylene, chlorinated solvents, welding fumes, and any types of solvents.

CONCLUSION:

Results confirm the influence of occupational risk factors in the occurrence of SS in both men and women. The link is not only with silica but also with other compounds such as solvents.
PMID:
 
12151611
 
[PubMed - indexed for MEDLINE] 
PMCID:
 
PMC1740346
 
Free PMC Article

Popular Posts