Clodoveo Ferri1, Erica Artoni2, Gian Luca Sighinolfi2, Fabrizio Luppi3, Gabriele Zelent4, Michele Colaci2, Dilia Giuggioli2. 1. Chair and Rheumatology Unit, Medical School, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria, Modena, Italy. Electronic address: clferri@unimore.it. 2. Chair and Rheumatology Unit, Medical School, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria, Modena, Italy. 3. Center for Rare Lung Diseases, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria, Modena, Italy. 4. Department of Neuroscience, Biomedical and Metabolic Sciences, University of Modena and Reggio Emilia, Modena, Italy.
Abstract
BACKGROUND: Systemic sclerosis (SSc) is an autoimmune systemic disease characterized by diffuse fibrosis of skin and visceral organs due to different genetic, infectious, and/or environmental/occupational causative factors, including the inhalation of silica dust. OBJECTIVES: To investigate serum trace elements including silicon (s-Si) levels in SSc patients living in a restricted geographical area with high density of worksites with silica exposure hazard. METHODS: This case-control study included 80 SSc patients (M:F 10:70; aged 58.4 ± 11.9SD years, mean disease duration 10.1 ± 7.8SD) and 50 age-/sex-matched healthy control subjects consecutively investigated at our University-based Rheumatology Unit. Patients and controls were evaluated for environmental/occupational exposure categories (structured questionnaire), morphological characterization of serum micro-/nanoparticles (Environmental Scanning Electron Microscopy and Energy Dispersive X-ray Spectroscopy microanalysis), and quantitative assessment of trace elements (inductively coupled plasma atomic emission spectroscopy). RESULTS: Among various categories, only occupational exposure to silica dust was recorded in a significant proportion of SSc patients compared to controls (55% vs. 11%; p < .0001). Qualitative analysis showed serum silica micro- and nanoparticles in all exposed patients. Quantitative evaluation evidenced significantly higher s-Si levels in SSc patients versus controls (p < .0001); in addition, higher s-Si levels were detected in patients with occupational exposure (p < .0001), diffuse cutaneous SSc (p = .0047), myositis (p = .0304), and/or lung fibrosis (p = .0004) compared to those without; notably, the severity of lung fibrosis scoring positively correlated with s-Si levels (p < .0001). CONCLUSIONS: The study first demonstrated high s-Si levels in exposed SSc patients; this element might represent a pathogenetic co-factor of more severe clinical phenotypes, mainly diffuse scleroderma with lung fibrosis.
BACKGROUND:Systemic sclerosis (SSc) is an autoimmune systemic disease characterized by diffuse fibrosis of skin and visceral organs due to different genetic, infectious, and/or environmental/occupational causative factors, including the inhalation of silica dust. OBJECTIVES: To investigate serum trace elements including silicon (s-Si) levels in SSc patients living in a restricted geographical area with high density of worksites with silica exposure hazard. METHODS: This case-control study included 80 SSc patients (M:F 10:70; aged 58.4 ± 11.9SD years, mean disease duration 10.1 ± 7.8SD) and 50 age-/sex-matched healthy control subjects consecutively investigated at our University-based Rheumatology Unit. Patients and controls were evaluated for environmental/occupational exposure categories (structured questionnaire), morphological characterization of serum micro-/nanoparticles (Environmental Scanning Electron Microscopy and Energy Dispersive X-ray Spectroscopy microanalysis), and quantitative assessment of trace elements (inductively coupled plasma atomic emission spectroscopy). RESULTS: Among various categories, only occupational exposure to silica dust was recorded in a significant proportion of SSc patients compared to controls (55% vs. 11%; p < .0001). Qualitative analysis showed serum silica micro- and nanoparticles in all exposed patients. Quantitative evaluation evidenced significantly higher s-Si levels in SSc patients versus controls (p < .0001); in addition, higher s-Si levels were detected in patients with occupational exposure (p < .0001), diffuse cutaneous SSc (p = .0047), myositis (p = .0304), and/or lung fibrosis (p = .0004) compared to those without; notably, the severity of lung fibrosis scoring positively correlated with s-Si levels (p < .0001). CONCLUSIONS: The study first demonstrated high s-Si levels in exposed SSc patients; this element might represent a pathogenetic co-factor of more severe clinical phenotypes, mainly diffuse scleroderma with lung fibrosis.
Authors: Lisbeth A Aguila; Henrique Carriço da Silva; Ana Cristina Medeiros-Ribeiro; Bruna Giusto Bunjes; Ana Paula Luppino-Assad; Percival D Sampaio-Barros Journal: Rheumatol Int Date: 2020-08-30 Impact factor: 2.631