Isabelle Marie1, Jean-François Menard2, Anne-Bénédicte Duval-Modeste3, Pascal Joly3, Stéphane Dominique4, Pierre Bravard5, David Noël6, Jean-François Gehanno7, Michael Bubenheim8, Jacques Benichou8, Hervé Levesque9. 1. Department of Internal Medicine, Centre Hospitalier Universitaire (CHU) Rouen, and Institut National de la Santé et de la Recherche Biomédicale (INSERM) Unit 905, University of Rouen Institut Fédératif Multidisciplinaire sur les Peptides (IFRMP), Institute for Biochemical Research, Rouen, France. Electronic address: isabelle.marie@chu-rouen.fr. 2. Department of Biostatistics, CHU Rouen, Rouen, France. 3. Department of Dermatology, CHU Rouen, Rouen, France. 4. Department of Pneumology, CHU Rouen, Rouen, France. 5. Department of Dermatology, CHG Le Havre, Le Havre, France. 6. Department of Internal Medicine, Centre Hospitalier Général (CHG) Elbeuf, Elbeuf, France. 7. Department of Occupational Medicine, CHU Rouen, Rouen, France. 8. Department of Epidemiology, CHU Rouen, Rouen, France. 9. Department of Internal Medicine, Centre Hospitalier Universitaire (CHU) Rouen, and Institut National de la Santé et de la Recherche Biomédicale (INSERM) Unit 905, University of Rouen Institut Fédératif Multidisciplinaire sur les Peptides (IFRMP), Institute for Biochemical Research, Rouen, France.
Abstract
BACKGROUND: Occupational exposure is reported as playing a substantial causative role in systemic sclerosis (SSc). OBJECTIVE: We sought to compare the characteristics of SSc in patients with and without occupational exposure to crystalline silica/solvents. METHODS: In all, 142 patients with SSc were enrolled in this prospective study. An expert committee performed blind evaluation of occupational exposure to crystalline silica/solvents. RESULTS: Patients exposed to crystalline silica more often exhibited: diffuse cutaneous SSc (P = .02), digital ulcers (P = .05), interstitial lung disease (P = .0004), myocardial dysfunction (P = .006), and cancer (P = .06). Patients exposed to solvents more frequently developed: diffuse cutaneous SSc (P = .001), digital ulcers (P = .01), interstitial lung disease (P = .02), myocardial dysfunction (P = .04), and cancer (P = .003); in addition, these patients were more frequently anti-Scl 70 positive and anticentromere negative. Under multivariate analysis, significant factors for SSc associated with exposure to silica/solvents were: male gender (odds ratio 19.31, 95% confidence interval 15.34-69.86), cancer (odds ratio 5.97, 95% confidence interval 1.55-23.01), and digital ulcers (odds ratio 2.42, 95% confidence interval 1.05-5.56). LIMITATIONS: The cohort originated from a single geographic region. 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.
BACKGROUND: Occupational exposure is reported as playing a substantial causative role in systemic sclerosis (SSc). OBJECTIVE: We sought to compare the characteristics of SSc in patients with and without occupational exposure to crystalline silica/solvents. METHODS: In all, 142 patients with SSc were enrolled in this prospective study. An expert committee performed blind evaluation of occupational exposure to crystalline silica/solvents. RESULTS:Patients exposed to crystalline silica more often exhibited: diffuse cutaneous SSc (P = .02), digital ulcers (P = .05), interstitial lung disease (P = .0004), myocardial dysfunction (P = .006), and cancer (P = .06). Patients exposed to solvents more frequently developed: diffuse cutaneous SSc (P = .001), digital ulcers (P = .01), interstitial lung disease (P = .02), myocardial dysfunction (P = .04), and cancer (P = .003); in addition, these patients were more frequently anti-Scl 70 positive and anticentromere negative. Under multivariate analysis, significant factors for SSc associated with exposure to silica/solvents were: male gender (odds ratio 19.31, 95% confidence interval 15.34-69.86), cancer (odds ratio 5.97, 95% confidence interval 1.55-23.01), and digital ulcers (odds ratio 2.42, 95% confidence interval 1.05-5.56). LIMITATIONS: The cohort originated from a single geographic region. 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.
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