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Kilbo Edlund K, Andersson EM, Andersson M, Barregard L, Christensson A, Johannesson S, Harari F, Murgia N, Torén K, Stockfelt L. Occupational particle exposure and chronic kidney disease: a cohort study in Swedish construction workers. Occup Environ Med 2024; 81:238-243. [PMID: 38811167 PMCID: PMC11187372 DOI: 10.1136/oemed-2023-109371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 05/19/2024] [Indexed: 05/31/2024]
Abstract
OBJECTIVES Increasing epidemiological and experimental evidence suggests that particle exposure is an environmental risk factor for chronic kidney disease (CKD). However, only a few case-control studies have investigated this association in an occupational setting. Hence, our objective was to investigate associations between particle exposure and CKD in a large cohort of Swedish construction workers. METHODS We performed a retrospective cohort study in the Swedish Construction Workers' Cohort, recruited 1971-1993 (n=286 089). A job-exposure matrix was used to identify workers exposed to nine different particulate exposures, which were combined into three main categories (inorganic dust and fumes, wood dust and fibres). Incident CKD and start of renal replacement therapy (RRT) were obtained from validated national registries until 2021 and analysed using adjusted Cox proportional hazards models. RESULTS Exposure to inorganic dust and fumes was associated with an increased risk of CKD and RRT during working age (adjusted HR for CKD at age <65 years 1.15, 95% CI 1.05 to 1.26). The elevated risk did not persist after retirement age. Exposure to cement dust, concrete dust and diesel exhaust was associated with CKD. Elevated HRs were also found for quartz dust and welding fumes. CONCLUSIONS Workers exposed to inorganic particles seem to be at elevated risk of CKD and RRT. Our results are in line with previous evidence of renal effects of ambient air pollution and warrant further efforts to reduce occupational and ambient particle exposure.
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Affiliation(s)
- Karl Kilbo Edlund
- School of Public Health and Community Medicine, University of Gothenburg, Goteborg, Sweden
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Eva M Andersson
- School of Public Health and Community Medicine, University of Gothenburg, Goteborg, Sweden
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Martin Andersson
- Department of Public Health and Clinical Medicine, Umeå University, Umea, Sweden
| | - Lars Barregard
- School of Public Health and Community Medicine, University of Gothenburg, Goteborg, Sweden
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Anders Christensson
- Department of Nephrology, Lund University, Lund, Sweden
- Department of Nephrology, Skåne University Hospital Nephrology, Malmö, Sweden
| | - Sandra Johannesson
- School of Public Health and Community Medicine, University of Gothenburg, Goteborg, Sweden
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Florencia Harari
- School of Public Health and Community Medicine, University of Gothenburg, Goteborg, Sweden
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Nicola Murgia
- Department of Environmental and Prevention Sciences, University of Ferrara, Ferrara, Italy
| | - Kjell Torén
- School of Public Health and Community Medicine, University of Gothenburg, Goteborg, Sweden
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Leo Stockfelt
- School of Public Health and Community Medicine, University of Gothenburg, Goteborg, Sweden
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Goteborg, Sweden
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Huang X, Liang R, Liu Y, Yu L, Yang M, Shang B, Zhang H, Ma J, Chen W, Wang D. Incidence, mortality, and disability-adjusted life years due to silicosis worldwide, 1990-2019: evidence from the global burden of disease study 2019. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2024; 31:36910-36924. [PMID: 38758446 DOI: 10.1007/s11356-024-33701-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 05/13/2024] [Indexed: 05/18/2024]
Abstract
Silicosis is an occupational lung disease because of exposure to silica dust in the workplace. Evidence on the spatiotemporal change of silicosis burden worldwide remains limited. This study utilized data extracted from the Global Burden of Disease Study 2019 to examine the numbers and age-standardized rates of incidence (ASIR), mortality (ASMR), and disability-adjusted life years (DALYs) caused by silicosis between 1990 and 2019. Average annual percentage changes (AAPCs) were calculated to evaluate the temporal trends of age-standardized indicators by sex, region, and socio-demographic index (SDI) since 1990. Results indicated an increase in new silicosis cases globally, rising by 64.61% from 84,426 in 1990 to 138,971 in 2019, with a sustained high number of DALYs attributed to this disease. Although the global age-standardized rates of incidence, mortality, and DALYs of silicosis have decreased since 1990, the number of new cases has increased in 168 countries and territories, and the ASIR of silicosis has also risen in 118 countries and territories, primarily in developing countries. Since 1990, the burden of silicosis among the elderly has significantly increased. Countries with higher SDI experienced a more rapid decline in the silicosis burden. Silicosis remains a public health problem that requires significant attention. Programs for prevention and elimination of this public health issue need to be established in more countries and territories. Protecting young workers from silica dust exposure is crucial to prevent the onset of silicosis in their later years and to reduce the disease burden among older workers.
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Affiliation(s)
- Xuezan Huang
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Ruyi Liang
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yang Liu
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Linling Yu
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Meng Yang
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430000, China
| | - Bingxin Shang
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Haozhe Zhang
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jixuan Ma
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Weihong Chen
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Dongming Wang
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China.
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Yamamoto S, Yoshida A, Gono T, Kuwana M. The Role of Environmental Factors in the Development of Idiopathic Inflammatory Myopathies: a Narrative Review. Curr Rheumatol Rep 2023; 25:264-275. [PMID: 37971581 DOI: 10.1007/s11926-023-01120-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE OF REVIEW This review aims to evaluate recent findings on the role of environmental factors in the development and clinical presentation of idiopathic inflammatory myopathies (IIMs). RECENT FINDINGS A targeted literature review was conducted to identify reports relevant to the association between environmental factors and IIMs published over the past three years. There has been an increasing number of publications dealing with the association of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or vaccination with the development of IIMs, highlighting the significant role of the antiviral immune response in the pathogenesis of the disease. Traditional environmental factors associated with the pathogenic process of IIM subclassifications included drugs such as statins and immune checkpoint inhibitors, ultraviolet radiation, smoking, air pollutants, and vitamin D deficiency. Correlations of seasonality and residence with the onset of certain IIM subtypes suggest a potential role of environmental triggers in the pathogenic process. An interplay between genetic predisposition and various environmental factors might contribute to the development of IIMs as well as the heterogeneous clinical and serological presentation of IIMs. The growing evidence on the role of environmental factors in the development of IIMs provides important clues to elucidate the pathophysiology of these disease entities. The mechanisms underlying the interactions between genetic predisposition and environmental factors should be investigated in the future.
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Affiliation(s)
- Shintaro Yamamoto
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8602, Japan
| | - Akira Yoshida
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8602, Japan
| | - Takahisa Gono
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8602, Japan
- Scleroderma/Myositis Center of Excellence, Nippon Medical School Hospital, Tokyo, Japan
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo, 113-8602, Japan.
- Scleroderma/Myositis Center of Excellence, Nippon Medical School Hospital, Tokyo, Japan.
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Su TY, Lee LJH, Chen JM, Chung SH, Wu WT. Analyzing the incidence of silicosis across various industries in Taiwan: a study of occupational disease surveillance by linking national-based workers' and medicoadministrative databases. Public Health 2023; 225:110-119. [PMID: 37924635 DOI: 10.1016/j.puhe.2023.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/10/2023] [Accepted: 09/28/2023] [Indexed: 11/06/2023]
Abstract
OBJECTIVES This study aimed to establish an occupational disease surveillance system by identifying high-risk industries for silicosis in Taiwan using a national database linkage approach. METHODS The study was based on a comprehensive analysis of benefit claims from the National Labor Insurance Research Database and medical records from the National Health Insurance Research Database between 2004 and 2020, providing coverage for more than 88.5% of the workforce and 99.9% of citizens. Silicosis was defined as having received compensation for labor insurance benefits or having received a diagnosis of silicosis (International Classification of Diseases, 10th Revision: J62 or International Classification of Diseases, Ninth Revision: 502). The study used the International Standard Industrial Classification of All Economic Activities for industry-specific classification. Cox proportional hazard models were used to compare the silicosis incidence and risk among each industry and identify high-risk industries for silicosis. RESULTS This study analyzed 1466 cases of silicosis between 2004 and 2020 and found that 28 industries had incidence rates of over 40 cases per 100,000 workers, indicating more than double the risk of developing silicosis. Of these industries, 14 were considered high risk (relative risk of over four times). Among these, this study identified industries rarely mentioned in the past, such as wholesale of brick, sand, cement, and products, artistic creation, landscape construction, and materials recovery. Stratification by years of work experience reveals those industries such as quarrying of stone, sand, clay, and other mining, construction of buildings, landscape construction, site preparation, foundation and structure construction, building completion and finishing, manufacture of ships, boats, and floating structures, and plumbing, heat, and air conditioning installation display higher hazard ratios for individuals with <10 years of work experience. CONCLUSIONS The current surveillance system has identified certain industries that are at a higher risk of developing silicosis, which could be used for future occupational epidemiological surveys and targeted preventive measures in these sectors.
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Affiliation(s)
- T-Y Su
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli County, Taiwan; School of Public Health, National Defense Medical Center, Taipei City, Taiwan
| | - L J-H Lee
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli County, Taiwan; Institute of Environmental and Occupational Health Sciences, National Taiwan University, Taipei, Taiwan
| | - J-M Chen
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli County, Taiwan
| | - S-H Chung
- Institute of Labor, Occupational Safety and Health, Ministry of Labor, New Taipei City, Taiwan
| | - W-T Wu
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli County, Taiwan; Institute of Environmental and Occupational Health Sciences, National Yang-Ming Chiao Tung University, Taipei, Taiwan.
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Cavalin C, Lescoat A, Sigaux J, Macchi O, Ballerie A, Catinon M, Vincent M, Semerano L, Boissier MC, Rosental PA. Crystalline silica exposure in patients with rheumatoid arthritis and systemic sclerosis: a nationwide cross-sectional survey. Rheumatology (Oxford) 2023; 62:2707-2715. [PMID: 36458909 DOI: 10.1093/rheumatology/keac675] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 11/23/2022] [Indexed: 08/03/2023] Open
Abstract
OBJECTIVES Develop and validate a thorough exposure questionnaire to comprehensively explore crystalline silica (SiO2) exposure in the general population (gender-specific, occupational and non-occupational) and in patients with autoimmune diseases (rheumatoid arthritis (RA), systemic sclerosis (SSc)). METHODS Lifetime exposures to SiO2 in occupational and non-occupational settings were assessed using a thorough exposure questionnaire. The questionnaire was applied to a general population panel (n = 2911) sampled from the French rolling census, and to unselected patients with SSc (n = 100) and RA (n = 97). Global (GES), occupational (OES) and non-occupational (NOES) exposure scores were assessed in SSc and RA patients, and compared with up to four controls from the general population, matched by age group, sex and tobacco consumption. RESULTS Patients had higher GES than their matched controls (SSc: P = 0.001; RA: P < 0.0001) due to higher OES (P < 0.0001 for SSc and RA). Men had higher GES than women (SSc: P < 0.0001; RA: P = 0.002) due to higher OES (P < 0.0001 for SSc and RA). The NOES did not differ between men and women. In SSc patients: Men had higher GES than controls (P < 0.0001). Men and women with SSc had higher OES than controls (P < 0.0001). In RA patients: GES and OES were higher in both men (P = 0.00521; P < 0.0001) and women (P < 0.0001; P < 0.0001) than in their respective controls. Women had higher NOES than controls (P = 0.045). CONCLUSION The lifetime SiO2 exposure gap between RA and SSc patients and controls was substantially due to occupational exposure. In both diseases, men had higher exposure scores than women.
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Affiliation(s)
- Catherine Cavalin
- IRISSO, UMR CNRS-INRAE 7170-1427, Paris-Dauphine University, PSL, Paris, France
- Laboratory for Interdisciplinary Evaluation of Public Policies (LIEPP), Sciences Po,Paris, France
- Centre d'études de l'emploi et du travail (CEET, CNAM), Noisy-le-Grand, France
| | - Alain Lescoat
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, Rennes, France
- Inserm, EHESP, Irset (Institute for Research in Health, Environment and Work) - UMR_S 1085, Rue du Thabor, France
| | - Johanna Sigaux
- Inserm U1125, Sorbonne Paris Nord University, Li2P, Bobigny, France
- Rheumatology Department, Assistance Publique-Hôpitaux de Paris, GH HUPSSD, Bobigny, France
| | - Odile Macchi
- Investigation Department of the International Observatory of Prisons (OIP), Paris, France
- Centre for the Study of Social Movements (CEMS), École des Hautes Études en Sciences Sociales (EHESS), Paris, France
| | - Alice Ballerie
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, Rennes, France
- Inserm, EHESP, Irset (Institute for Research in Health, Environment and Work) - UMR_S 1085, Rue du Thabor, France
| | | | | | - Luca Semerano
- Inserm U1125, Sorbonne Paris Nord University, Li2P, Bobigny, France
- Rheumatology Department, Assistance Publique-Hôpitaux de Paris, GH HUPSSD, Bobigny, France
| | - Marie-Christophe Boissier
- Inserm U1125, Sorbonne Paris Nord University, Li2P, Bobigny, France
- Rheumatology Department, Assistance Publique-Hôpitaux de Paris, GH HUPSSD, Bobigny, France
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Lee S, Kim YJ, Kim Y, Kang D, Kim SC, Kim SY. Incidence rates of injury, musculoskeletal, skin, pulmonary and chronic diseases among construction workers by classification of occupations in South Korea: a 1,027 subject-based cohort of the Korean Construction Worker's Cohort (KCWC). Ann Occup Environ Med 2023; 35:e26. [PMID: 37614337 PMCID: PMC10442585 DOI: 10.35371/aoem.2023.35.e26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 05/23/2023] [Accepted: 06/12/2023] [Indexed: 08/25/2023] Open
Abstract
Background The objective of this study is to investigate the differences in incidence rates of targeted diseases by classification of occupations among construction workers in Korea. Methods In a subject-based cohort of the Korean Construction Worker's Cohort, we surveyed a total of 1,027 construction workers. As occupational exposure, the classification of occupations was developed using two axes: construction business and job type. To analyze disease incidence, we linked survey data with National Health Insurance Service data. Eleven target disease categories with high prevalence or estimated work-relatedness among construction workers were evaluated in our study. The average incidence rates were calculated as cases per 1,000 person-years (PY). Results Injury, poisoning, and certain other consequences of external causes had the highest incidence rate of 344.08 per 1,000 PY, followed by disease of the musculoskeletal system and connective tissue for 208.64 and diseases of the skin and subcutaneous tissue for 197.87 in our cohort. We especially found that chronic obstructive pulmonary disease was more common in construction painters, civil engineering welders, and civil engineering frame mold carpenters, asthma in construction painters, landscape, and construction water proofers, interstitial lung diseases in construction water proofers. Conclusions This is the first study to systematically classify complex construction occupations in order to analyze occupational diseases in Korean construction workers. There were differences in disease incidences among construction workers based on the classification of occupations. It is necessary to develop customized occupational safety and health policies for high-risk occupations for each disease in the construction industry.
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Affiliation(s)
- Seungho Lee
- Department of Occupational and Environmental Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Yoon-Ji Kim
- Department of Preventive, and Occupational & Environmental Medicine, School of Medicine, Pusan National University, Yangsan, Korea
| | - Youngki Kim
- Department of Occupational and Environmental Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Preventive, and Occupational & Environmental Medicine, School of Medicine, Pusan National University, Yangsan, Korea
| | - Dongmug Kang
- Department of Occupational and Environmental Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Preventive, and Occupational & Environmental Medicine, School of Medicine, Pusan National University, Yangsan, Korea
| | - Seung Chan Kim
- Department of Biostatistics Cooperation Center, Gyeongsang National University Hospital, Jinju, Korea
| | - Se-Yeong Kim
- Department of Occupational and Environmental Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Preventive, and Occupational & Environmental Medicine, School of Medicine, Pusan National University, Yangsan, Korea
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Wang M, Yao G, Sun Y, Yang Y, Deng R. Exposure to construction dust and health impacts - A review. CHEMOSPHERE 2023; 311:136990. [PMID: 36309055 DOI: 10.1016/j.chemosphere.2022.136990] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/03/2022] [Accepted: 10/20/2022] [Indexed: 06/16/2023]
Abstract
Construction dust contributes a significant proportion of airborne particulate matter, affecting the health of its surrounding environment and population. Construction workers are normally exposed to dust at high levels and bear severe health risks. The existing articles concerning the exposure and health impacts of construction dust are limited, but this research field has received more and more attention. This work reviews literature in the field and tries to systematically assess the current research state. Here, we review (1) methods used to monitor or sample construction dust; (2) main characteristics of construction dust, including dust classification, exposed populations, and exposure concentrations; (3) potential health hazards and (4) health risk assessment of construction dust. From existing literature, the exposure concentrations of different types and sources of construction dust are usually the focus of attention, while its particle size distribution and chemical composition are rarely mentioned. The classification and characteristics of populations exposed to construction dust ought to be a key consideration but not clear enough so far. There still lacks in-depth study of health hazards and systematic assessment of risks associated with construction dust. In future, it is valuable to develop utility instruments to precisely monitor construction dust. Besides, control means to reduce the pollution of construction dust deserve more studies. Health hazards of construction dust should be verified by biological experiments. Moreover, emerging algorithm models should be utilized in the risk assessment. The findings will help gain a better understanding of construction dust exposure and associated health risks.
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Affiliation(s)
- Mingpu Wang
- School of Civil Engineering, Chongqing University, Chongqing, 400045, China; Key Laboratory of New Technology for Construction of Cities in Mountain Area, Ministry of Education, Chongqing, 400045, China
| | - Gang Yao
- School of Civil Engineering, Chongqing University, Chongqing, 400045, China; Key Laboratory of New Technology for Construction of Cities in Mountain Area, Ministry of Education, Chongqing, 400045, China
| | - Yujia Sun
- School of Civil Engineering, Chongqing University, Chongqing, 400045, China; Key Laboratory of New Technology for Construction of Cities in Mountain Area, Ministry of Education, Chongqing, 400045, China
| | - Yang Yang
- School of Civil Engineering, Chongqing University, Chongqing, 400045, China; Key Laboratory of New Technology for Construction of Cities in Mountain Area, Ministry of Education, Chongqing, 400045, China
| | - Rui Deng
- School of Civil Engineering, Chongqing University, Chongqing, 400045, China.
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Che WI, Lundberg IE, Holmqvist M. Environmental Risks for Inflammatory Myopathies. Rheum Dis Clin North Am 2022; 48:861-874. [PMID: 36333000 DOI: 10.1016/j.rdc.2022.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This is an up-to-date review on external environmental factors for adult-onset idiopathic inflammatory myopathies (IIMs). Environmental factors with suggestive evidence including ultraviolet radiation, smoking, infectious agents (viruses in particular), pollutants, medications (ie, statin) and vitamin D deficiency are discussed. We also discuss the potential implications of environmental factors in IIM development, identify current challenges, and provide insight into future investigations.
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Affiliation(s)
- Weng Ian Che
- Department of Medicine, Solna, Eugeniahemmet, T2, Karolinska Universitetssjukhuset, Solna, Stockholm 171 76, Sweden; Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Ingrid E Lundberg
- Rheumatology, Karolinska University Hospital, Anna Steckséns gata 30A, Stockholm 171 76, Sweden; Division of Rheumatology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; ME Gastro, Derm and Rheuma, Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden.
| | - Marie Holmqvist
- Department of Medicine, Solna, Eugeniahemmet, T2, Karolinska Universitetssjukhuset, Solna, Stockholm 171 76, Sweden; Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Rheumatology, Karolinska University Hospital, Anna Steckséns gata 30A, Stockholm 171 76, Sweden; Division of Rheumatology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
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Liu JL, Woo JMP, Parks CG, Costenbader KH, Jacobsen S, Bernatsky S. Systemic Lupus Erythematosus Risk: The Role of Environmental Factors. Rheum Dis Clin North Am 2022; 48:827-843. [PMID: 36332998 DOI: 10.1016/j.rdc.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Systemic lupus erythematosus (SLE) is a complex, chronic autoimmune disease. The etiology of SLE is multifactorial and includes potential environmental triggers, which may occur sequentially (the "multi-hit" hypothesis). This review focuses on SLE risk potentially associated with environmental factors including infections, the microbiome, diet, respirable exposures (eg, crystalline silica, smoking, air pollution), organic pollutants, heavy metals, and ultraviolet radiation.
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Affiliation(s)
- Jia Li Liu
- McGill University, Montreal, Quebec, Canada
| | - Jennifer M P Woo
- Epidemiology Branch, Department of Health and Human Services, National Institutes of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, USA
| | - Christine G Parks
- Epidemiology Branch, Department of Health and Human Services, National Institutes of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, USA
| | - Karen H Costenbader
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Søren Jacobsen
- Copenhagen Lupus and Vasculitis Clinic, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Sasha Bernatsky
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
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Frazzei G, van Vollenhoven RF, de Jong BA, Siegelaar SE, van Schaardenburg D. Preclinical Autoimmune Disease: a Comparison of Rheumatoid Arthritis, Systemic Lupus Erythematosus, Multiple Sclerosis and Type 1 Diabetes. Front Immunol 2022; 13:899372. [PMID: 35844538 PMCID: PMC9281565 DOI: 10.3389/fimmu.2022.899372] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/30/2022] [Indexed: 12/16/2022] Open
Abstract
The preclinical phase of autoimmune disorders is characterized by an initial asymptomatic phase of varying length followed by nonspecific signs and symptoms. A variety of autoimmune and inflammatory manifestations can be present and tend to increase in the last months to years before a clinical diagnosis can be made. The phenotype of an autoimmune disease depends on the involved organs, the underlying genetic susceptibility and pathophysiological processes. There are different as well as shared genetic or environmental risk factors and pathophysiological mechanisms between separate diseases. To shed more light on this, in this narrative review we compare the preclinical disease course of four important autoimmune diseases with distinct phenotypes: rheumatoid arthritis (RA), Systemic Lupus Erythematosus (SLE), multiple sclerosis (MS) and type 1 diabetes (T1D). In general, we observed some notable similarities such as a North-South gradient of decreasing prevalence, a female preponderance (except for T1D), major genetic risk factors at the HLA level, partly overlapping cytokine profiles and lifestyle risk factors such as obesity, smoking and stress. The latter risk factors are known to produce a state of chronic systemic low grade inflammation. A central characteristic of all four diseases is an on average lengthy prodromal phase with no or minor symptoms which can last many years, suggesting a gradually evolving interaction between the genetic profile and the environment. Part of the abnormalities may be present in unaffected family members, and autoimmune diseases can also cluster in families. In conclusion, a promising strategy for prevention of autoimmune diseases might be to address adverse life style factors by public health measures at the population level.
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Affiliation(s)
- Giulia Frazzei
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Centre, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
- Department of Experimental Immunology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
- *Correspondence: Giulia Frazzei,
| | - Ronald F. van Vollenhoven
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Centre, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Rheumatology Center, Amsterdam, Netherlands
| | - Brigit A. de Jong
- Department of Neurology, MS Center Amsterdam, Amsterdam University Medical Center (UMC), Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - Sarah E. Siegelaar
- Department of Endocrinology and Metabolism, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Dirkjan van Schaardenburg
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Centre, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, Netherlands
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11
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Woo JMP, Parks CG, Jacobsen S, Costenbader KH, Bernatsky S. The role of environmental exposures and gene-environment interactions in the etiology of systemic lupus erythematous. J Intern Med 2022; 291:755-778. [PMID: 35143075 DOI: 10.1111/joim.13448] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Systemic lupus erythematosus (SLE) is a complex, chronic autoimmune disease, whose etiology includes both genetic and environmental factors. Individual genetic risk factors likely only account for about one-third of observed heritability among individuals with a family history of SLE. A large portion of the remaining risk may be attributable to environmental exposures and gene-environment interactions. This review focuses on SLE risk associated with environmental factors, ranging from chemical and physical environmental exposures to lifestyle behaviors, with the weight of evidence supporting positive associations between SLE and occupational exposure to crystalline silica, current smoking, and exogenous estrogens (e.g., oral contraceptives and postmenopausal hormones). Other risk factors may include lifestyle behaviors (e.g., dietary intake and sleep) and other exposures (e.g., ultraviolet [UV] radiation, air pollution, solvents, pesticides, vaccines and medications, and infections). Alcohol use may be associated with decreased SLE risk. We also describe the more limited body of knowledge on gene-environment interactions and SLE risk, including IL-10, ESR1, IL-33, ITGAM, and NAT2 and observed interactions with smoking, UV exposure, and alcohol. Understanding genetic and environmental risk factors for SLE, and how they may interact, can help to elucidate SLE pathogenesis and its clinical heterogeneity. Ultimately, this knowledge may facilitate the development of preventive interventions that address modifiable risk factors in susceptible individuals and vulnerable populations.
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Affiliation(s)
- Jennifer M P Woo
- Epidemiology Branch, National Institutes of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, USA
| | - Christine G Parks
- Epidemiology Branch, National Institutes of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, USA
| | - Søren Jacobsen
- Copenhagen Lupus and Vasculitis Clinic, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Karen H Costenbader
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sasha Bernatsky
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
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12
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Hoy RF, Jeebhay MF, Cavalin C, Chen W, Cohen RA, Fireman E, Go LHT, León-Jiménez A, Menéndez-Navarro A, Ribeiro M, Rosental PA. Current global perspectives on silicosis-Convergence of old and newly emergent hazards. Respirology 2022; 27:387-398. [PMID: 35302259 PMCID: PMC9310854 DOI: 10.1111/resp.14242] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 01/05/2022] [Indexed: 01/03/2023]
Abstract
Silicosis not a disease of the past. It is an irreversible, fibrotic lung disease specifically caused by exposure to respirable crystalline silica (RCS) dust. Over 20,000 incident cases of silicosis were identified in 2017 and millions of workers continue to be exposed to RCS. Identified case numbers are however a substantial underestimation due to deficiencies in reporting systems and occupational respiratory health surveillance programmes in many countries. Insecure workers, immigrants and workers in small businesses are at particular risk of more intense RCS exposure. Much of the focus of research and prevention activities has been on the mining sector. Hazardous RCS exposure however occurs in a wide range of occupational setting which receive less attention, in particular the construction industry. Recent outbreaks of silicosis associated with the fabrication of domestic kitchen benchtops from high‐silica content artificial stone have been particularly notable because of the young age of affected workers, short duration of RCS exposure and often rapid disease progression. Developments in nanotechnology and hydraulic fracking provide further examples of how rapid changes in technology and industrial processes require governments to maintain constant vigilance to identify and control potential sources of RCS exposure. Despite countries around the world dealing with similar issues related to RCS exposure, there is an absence of sustained global public health response including lack of consensus of an occupational exposure limit that would provide protection to workers. Although there are complex challenges, global elimination of silicosis must remain the goal. See relatedEditorial
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Affiliation(s)
- Ryan F Hoy
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Department of Respiratory Medicine, The Alfred Hospital, Prahran, Victoria, Australia
| | - Mohamed F Jeebhay
- Occupational Medicine Division and Centre for Environmental & Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Catherine Cavalin
- CNRS (IRISSO, UMR CNRS-INRAE 7170-1427), Université Paris-Dauphine, PSL, Soutien à la mobilité internationale (SMI) du CNRS, Paris, France.,Madrid Institute for Advanced Study (MIAS), Madrid, Spain.,Interdisciplinary Laboratory for the Evaluation of Public Policies, LIEPP, Sciences Po, Paris, France.,Employment and Labour Research Centre, CNAM, Noisy-le-Grand, France
| | - Weihong Chen
- Key Laboratory of Environment and Health, Ministry of Education and Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Robert A Cohen
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Environmental and Occupational Health Sciences Division, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
| | - Elizabeth Fireman
- Institute of Pulmonary and Allergic Diseases, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel.,Department Occupational Environmental Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Leonard H T Go
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Environmental and Occupational Health Sciences Division, School of Public Health, University of Illinois Chicago, Chicago, Illinois, USA
| | - Antonio León-Jiménez
- Pulmonology, Allergy and Thoracic Surgery Department, Puerta del Mar University Hospital, Cádiz, Spain
| | | | - Marcos Ribeiro
- Pulmonary Department, Universidade Estadual de Londrina: Londrina, Paraná, Brazil
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13
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Schmajuk G, Trupin L, Yelin EH, Blanc PD. Dusty trades and associated rheumatoid arthritis in a population-based study in the coal mining counties of Appalachia. Occup Environ Med 2022; 79:308-314. [PMID: 34987082 DOI: 10.1136/oemed-2021-107899] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 12/01/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We previously showed increased coal mining-associated risk of rheumatoid arthritis (RA). Using additional survey data, we sought to delineate this risk further. METHODS We used data from two cross-sectional, random-digit-dial, population-based surveys (males;≥50 years) in selected counties in the Appalachian region of the inland, mid-Atlantic USA with elevated pneumoconiosis mortality. Surveys ascertained age, smoking, coal mining and non-coal silica exposure jobs. In a subset, we surveyed ergonomic exposures, scored by intensity. We queried diagnosis of RA, corticosteroid use, and, in a subset, use of disease modifying antirheumatic drugs (DMARDs). Multivariable logistic regression modelled RA risk (defined by glucocorticoid or DMARDs use) associated with coal mining employment, other silica exposure, smoking status, and age and ergonomic exposures. RESULTS We analysed data for 2981 survey respondents (mean age 66.6 years; 15% current, 44% ex-smokers). The prevalence of glucocorticoid-treated and DMARD-treated RA was 11% and 4%, respectively. Glucocorticoid-treated RA was associated with coal mining (OR 3.5; 95% CI 2.5 to 4.9) and non-coal mining silica exposure (OR 3.2; 95% CI 2.4 to 4.4). For DMARD-treated RA, the odds associated with coal mining and other silica remained elevated: OR 2.3 (95% CI 1.18, 4.5) and OR 2.7 (95% CI 1.51, 5.0), respectively. In the same model, the highest intensity ergonomic exposure also was associated with increased odds of RA (OR 4.3; 95% CI 1.96 to 9.6). CONCLUSIONS We observed a strong association between coal mining and other silica-exposing dusty trades and RA. Clinicians and insurers should consider occupational histories in the aetiology of RA.
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Affiliation(s)
- Gabriela Schmajuk
- Medicine, Veterans Health Administration, San Francisco, California, USA.,Medicine, University of California San Francisco, San Francisco, California, USA
| | - Laura Trupin
- Medicine, University of California San Francisco, San Francisco, California, USA
| | - Edward H Yelin
- Medicine, University of California San Francisco, San Francisco, California, USA
| | - Paul D Blanc
- Medicine, Veterans Health Administration, San Francisco, California, USA .,Medicine, University of California San Francisco, San Francisco, California, USA
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14
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Romão VC, Fonseca JE. Etiology and Risk Factors for Rheumatoid Arthritis: A State-of-the-Art Review. Front Med (Lausanne) 2021; 8:689698. [PMID: 34901047 PMCID: PMC8661097 DOI: 10.3389/fmed.2021.689698] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 11/04/2021] [Indexed: 12/24/2022] Open
Abstract
Rheumatoid arthritis (RA) is the most common systemic inflammatory rheumatic disease. It is associated with significant burden at the patient and societal level. Extensive efforts have been devoted to identifying a potential cause for the development of RA. Epidemiological studies have thoroughly investigated the association of several factors with the risk and course of RA. Although a precise etiology remains elusive, the current understanding is that RA is a multifactorial disease, wherein complex interactions between host and environmental factors determine the overall risk of disease susceptibility, persistence and severity. Risk factors related to the host that have been associated with RA development may be divided into genetic; epigenetic; hormonal, reproductive and neuroendocrine; and comorbid host factors. In turn, environmental risk factors include smoking and other airborne exposures; microbiota and infectious agents; diet; and socioeconomic factors. In the present narrative review, aimed at clinicians and researchers in the field of RA, we provide a state-of-the-art overview of the current knowledge on this topic, focusing on recent progresses that have improved our comprehension of disease risk and development.
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Affiliation(s)
- Vasco C Romão
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ERN-ReCONNET), Lisbon, Portugal.,Rheumatology Research Unit, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - João Eurico Fonseca
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre and European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ERN-ReCONNET), Lisbon, Portugal.,Rheumatology Research Unit, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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15
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Rheumatoid Arthritis in Silica-Exposed Workers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312776. [PMID: 34886499 PMCID: PMC8657481 DOI: 10.3390/ijerph182312776] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 11/29/2021] [Accepted: 12/02/2021] [Indexed: 11/21/2022]
Abstract
Few studies have examined rheumatoid arthritis (RA) risk and severity in Korean workers exposed to silica. We compared the hospitalization risk of RA between silica-exposed workers and the general Korean population. The study cohort consisted of male workers exposed to silica who had undergone at least one silica-associated special medical examination between 1 January 2000 and 31 December 2004 (N = 149,948). The data were from the Korea Occupation Safety and Health Agency. RA morbidity based on hospital admission records was estimated from 2000 to 2005 using the Korea National Health Insurance Service claims data. The standardized admission ratio (SAR) was calculated by dividing the observed number of admissions in silica-exposed workers by the expected number of admissions in the general reference population. For the sum of “Seropositive rheumatoid arthritis” (M05) and “Other rheumatoid arthritis” (M06), the SAR was higher in the silica-exposed group (1.34, 95% CI 1.08–1.64). For M05, workers with <10 years of silica exposure had a significantly higher SAR (2.54, 95% CI 1.10–5.01) than the general population. More silica-exposed workers without a diagnosis of pneumoconiosis were hospitalized for RA than the general population. Our analysis reaffirms the link between silica exposure and RA and suggests that the severity of RA is increased by silica. Further studies of silica-exposed workers with longer follow-up are needed.
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16
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Celen H, Dens AC, Ronsmans S, Michiels S, De Langhe E. Airborne pollutants as potential triggers of systemic autoimmune rheumatic diseases: a narrative review. Acta Clin Belg 2021; 77:874-882. [PMID: 34666637 DOI: 10.1080/17843286.2021.1992582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The pathogenesis of systemic autoimmune rheumatic diseases (SARDs) is complex and remains insufficiently understood. It is commonly accepted that both intrinsic and extrinsic environmental factors interact to induce a self-reactive immune response. Case reports and observational studies have revealed an association between SARDs and specific airborne environmental factors, but the heterogeneity of the published studies hampers clear conclusions. The aim of this review is to provide an overview of the available epidemiological evidence on the relationship between airborne pollutants and SARDs. We performed a narrative review using the PubMed database. Observational studies have shown significant associations between airborne pollutants and SARDs. Cigarette smoking is strongly associated with the development of rheumatoid arthritis (RA) while the association between cigarette smoke and the development of other SARDs remains controversial. For decades, silica exposure has been linked to systemic sclerosis (SSc), RA and systemic lupus erythematosus (SLE). There is also strong evidence for a link between solvents and SSc. Recent observations even suggest that ambient air pollution is associated with the development of SARDs. Some studies have shown associations between asbestos, organic dust, metals and pesticides and SARDs, but more studies are needed to confirm these findings. Increasing evidence has linked airborne pollutants to SARDs. Although more studies are needed to understand the potential mechanisms by which these environmental agents contribute to disease pathogenesis, awareness of the link between environmental agents and SARDs is important to recognize and prevent work-related and environmentally induced diseases.
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Affiliation(s)
- Hannelore Celen
- Department of Rheumatology, University Hospitals Leuven, Leuven, Belgium
| | - Anne-Cathérine Dens
- Skeletal Biology and Engineering Research Centre, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Dermatology, University Hospitals Leuven, Leuven, Belgium
| | - Steven Ronsmans
- Clinic for Occupational and Environmental Medicine, Department of Pulmonary Medicine, University Hospitals Leuven, Leuven, Belgium
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Stijn Michiels
- Department of Rheumatology, Imelda General Hospital, Bonheiden, Belgium
| | - Ellen De Langhe
- Department of Rheumatology, University Hospitals Leuven, Leuven, Belgium
- Skeletal Biology and Engineering Research Centre, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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17
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Ying D, Schmajuk G, Trupin L, Blanc PD. Inorganic Dust Exposure During Military Service as a Predictor of Rheumatoid Arthritis and Other Autoimmune Conditions. ACR Open Rheumatol 2021; 3:466-474. [PMID: 34085777 PMCID: PMC8281049 DOI: 10.1002/acr2.11273] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE Rheumatoid arthritis (RA) and other autoimmune (AI) conditions are associated with inorganic dust exposure. Many military activities are likely to entail inorganic dust exposures. We wished to identify associations between prior military dust exposure and RA and other AI conditions. METHODS We studied persons from a roster of Army, Navy, Air Force, or Marine Corps personnel who had served in Operation Enduring Freedom and Operations Iraqi Freedom and New Dawn. We linked military occupational codes to a job exposure matrix assigning dust exposure likelihood. We used the Veterans Affairs Health Care System (VAHCS) electronic health care records to identify cases of RA, systemic lupus erythematosus (SLE), systemic sclerosis (SSc), vasculitis, and inflammatory myositis. Generalized estimating equations modeled risk of RA and other AI conditions associated with dust exposure, taking into account military service branch, age at first VAHCS encounter, sex, race/ethnicity, smoking status, and years of military service. RESULTS Of 438 086 veterans (68% ever-smokers), 44% were classified with likely or somewhat likely dust exposure. Cases included 1139 cases with RA, 467 cases with SLE, and 180 cases with other AI diseases (SSc, vasculitis, or inflammatory myositis). Military dust exposure was associated with increased odds of RA (odds ratio [OR] = 1.10; 95% confidence interval [CI] = 1.003-1.20) and increased odds of SSc, vasculitis, or inflammatory myositis (OR = 1.23; 95% CI = 1.14-1.34) but was protective for SLE (OR = 0.81; 95% CI = 0.76-0.88). CONCLUSION Dust exposure during past military service comprises an occupational and environmental risk factor for RA and other AI diseases. This is potentially relevant for prevention activities.
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Affiliation(s)
- David Ying
- San Francisco Veterans Affairs Health Care System, San Francisco, California, John Muir Health, Walnut Creek, California, and University of California at San Francisco
| | - Gabriela Schmajuk
- San Francisco Veterans Affairs Health Care System, San Francisco, California, and University of California at San Francisco
| | | | - Paul D. Blanc
- San Francisco Veterans Affairs Health Care System, San Francisco, California, and University of California at San Francisco
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18
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Abbasianjahromi H, Talebian R. Identifying the most important occupational diseases in the construction industry: case study of building industry in Iran. INTERNATIONAL JOURNAL OF CONSTRUCTION MANAGEMENT 2021. [DOI: 10.1080/15623599.2018.1518657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Hamidreza Abbasianjahromi
- Department of Civil Engineering, Civil Engineering Faculty, K. N. Toosi University of Technology, Tehran, Iran
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19
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Morotti A, Sollaku I, Franceschini F, Cavazzana I, Fredi M, Sala E, De Palma G. Systematic Review and Meta-analysis on the Association of Occupational Exposure to Free Crystalline Silica and Rheumatoid Arthritis. Clin Rev Allergy Immunol 2021; 62:333-345. [PMID: 33651342 PMCID: PMC8994741 DOI: 10.1007/s12016-021-08846-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2021] [Indexed: 01/01/2023]
Abstract
• Occupational exposure to free crystalline silica and tobacco smoking are associated with an increased risk rheumatoid arthritis, with the evidence of an interaction in seropositive subjects. • Further studies in the field are needed to support such association We carried out a systematic search for all published epidemiological studies concerning the association between occupational exposure to free crystalline silica (FCS) and subsequent development of rheumatoid arthritis (RA). A meta-analysis was conducted on relevant studies. We searched PubMed and Embase, search engines, for original articles published (from 1960 to November 2019) in any language. In addition, we also searched reference lists of included studies manually for additional relevant articles. Finally, twelve studies were included in the meta-analysis (seven case-control cases and five cohort studies). The odds risks and 95% confidence interval (CI) were calculated using a random effect meta-analysis. A primary meta-analysis (using a random effect model)—regarding RA risk in subjects exposed to FCS—yelled to an overall OR of 1.94 (95% CI 1.46–2.58). We also conducted three further meta-analysis, taking into account the presence of autoantibodies (anti-RF or anti-ACPA) and smoking habits and found a significant association between FCS and RA in both seropositive and seronegative subjects (OR 1.74, 95% CI 1.35–2.25 and OR 1.23, 95% CI 1.06–1.4, respectively) and in seropositive subjects which were smokers (OR 3.30, 95% CI 2.40–4.54). The studies that have investigated the association between RA and occupatational exposure to FCS are still scarce and the heterogeneity between the studies remains high. Some critical limitations have been identified within studies, among which, the methods for assessing exposure stand out. Although with due caution, our results confirm the hypothesis of an association between occupational exposure to FCS and RA development. There was an interaction between FCS and tobacco smoking in RA seropositive workers.
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Affiliation(s)
- A Morotti
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Unit of Occupational Health and Industrial Hygiene, University of Brescia, Piazzale Spedali Civili 1, 25121, Brescia, Italy
| | - I Sollaku
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Unit of Occupational Health and Industrial Hygiene, University of Brescia, Piazzale Spedali Civili 1, 25121, Brescia, Italy
| | - F Franceschini
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, Brescia, Italy
- University Hospital "Spedali Civili Di Brescia," Rheumatology, Department of Clinical and Experimental Sciences (DSCS), University of Brescia, Brescia, Italy
| | - I Cavazzana
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, Brescia, Italy
| | - M Fredi
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, Brescia, Italy
- University Hospital "Spedali Civili Di Brescia," Rheumatology, Department of Clinical and Experimental Sciences (DSCS), University of Brescia, Brescia, Italy
| | - E Sala
- Unit of Occupational Health, Hygiene, Toxicology and Occupational Prevention, University Hospital "Spedali Civili Di Brescia,", Brescia, Italy
| | - G De Palma
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Unit of Occupational Health and Industrial Hygiene, University of Brescia, Piazzale Spedali Civili 1, 25121, Brescia, Italy.
- Unit of Occupational Health, Hygiene, Toxicology and Occupational Prevention, University Hospital "Spedali Civili Di Brescia,", Brescia, Italy.
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20
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Ebel AV, Lutt G, Poole JA, Thiele GM, Baker JF, Cannon GW, Gaffo A, Kerr GS, Reimold A, Schwab P, Singh N, Richards JS, Ascherman DP, Mikuls TR, England BR. Association of Agricultural, Occupational, and Military Inhalants With Autoantibodies and Disease Features in US Veterans With Rheumatoid Arthritis. Arthritis Rheumatol 2021; 73:392-400. [PMID: 33058561 PMCID: PMC8236239 DOI: 10.1002/art.41559] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 10/02/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To determine the association of inhalant exposures with rheumatoid arthritis (RA)-related autoantibodies and severity in US veterans. METHODS Participants in the Veterans Affairs Rheumatoid Arthritis (VARA) registry were mailed surveys assessing occupational, agricultural, and military inhalant exposures. Demographic characteristics, disease activity, functional status, and extraarticular features were obtained from the VARA registry, while HLA-DRB1 shared epitope (SE) status, anti-cyclic citrullinated peptide (anti-CCP) antibodies, and rheumatoid factor (RF) were measured using banked DNA/serum from enrollment. Associations between inhalant exposures and RA-related factors (autoantibodies, severity, and extraarticular features) were assessed using multivariable linear and logistic regression models adjusted for age, sex, race, and tobacco use and stratified by SE status. Adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated. RESULTS Questionnaires were returned by 797 of 1,566 participants (50.9%). Survey respondents were older, more often White or male, and less frequently smokers, and had lower disease activity compared to nonrespondents. Anti-CCP positivity was more common among veterans exposed to burn pits (OR 1.66 [95% CI 1.02, 2.69]) and military waste disposal (OR 1.74 [95% CI 1.04, 2.93]) independent of other factors. Among participants who were positive for SE alleles, burn pit exposure (OR 5.69 [95% CI 2.73, 11.87]) and military waste disposal exposure (OR 5.05 [95% CI 2.42, 10.54]) were numerically more strongly associated with anti-CCP positivity. Several inhalant exposures were associated with the presence of chronic lung disease, but not with the presence of RF or the level of disease activity. CONCLUSION Military burn pit exposure and military waste disposal exposure were independently associated with the presence of anti-CCP antibodies in RA patients. These findings are consistent with emerging evidence that various inhalant exposures influence autoantibody expression and RA risk.
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Affiliation(s)
- Ariadne V. Ebel
- Ariadne V. Ebel, DO, Jill A. Poole, MD, Geoffrey M. Thiele, PhD, Ted R. Mikuls, MD, MSPH, Bryant R. England, MD, PhD: VA Nebraska–Western Iowa Health Care System and University of Nebraska Medical Center, Omaha
| | - Gabrielle Lutt
- Gabrielle Lutt: VA Nebraska–Western Iowa Health Care System and University of Nebraska Medical Center, Omaha, and University of Nebraska Lincoln
| | - Jill A. Poole
- Ariadne V. Ebel, DO, Jill A. Poole, MD, Geoffrey M. Thiele, PhD, Ted R. Mikuls, MD, MSPH, Bryant R. England, MD, PhD: VA Nebraska–Western Iowa Health Care System and University of Nebraska Medical Center, Omaha
| | - Geoffrey M. Thiele
- Ariadne V. Ebel, DO, Jill A. Poole, MD, Geoffrey M. Thiele, PhD, Ted R. Mikuls, MD, MSPH, Bryant R. England, MD, PhD: VA Nebraska–Western Iowa Health Care System and University of Nebraska Medical Center, Omaha
| | - Joshua F. Baker
- Joshua F. Baker, MD, MSCE: Philadelphia VA Medical Center and University of Pennsylvania, Philadelphia
| | - Grant W. Cannon
- Grant W. Cannon, MD: VA Salt Lake City Health Care System and University of Utah, Salt Lake City
| | - Angelo Gaffo
- Angelo Gaffo, MD, MSPH: Birmingham VA Medical Center and University of Alabama at Birmingham
| | - Gail S. Kerr
- Gail S. Kerr, MD: Washington, DC VA Medical Center, Georgetown University, and Howard University, Washington, DC
| | - Andreas Reimold
- Andreas Reimold, MD: Dallas VA Medical Center and University of Texas Southwestern, Dallas
| | - Pascale Schwab
- Pascale Schwab, MD: VA Portland Healthcare System and Oregon Health & Science University, Portland
| | - Namrata Singh
- Namrata Singh, MD, MSCI: University of Washington, Seattle
| | - J. Steuart Richards
- J. Steuart Richards, MBBS, Dana P. Ascherman, MD: VA Pittsburgh Health Care and University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Dana P. Ascherman
- J. Steuart Richards, MBBS, Dana P. Ascherman, MD: VA Pittsburgh Health Care and University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ted R. Mikuls
- Ariadne V. Ebel, DO, Jill A. Poole, MD, Geoffrey M. Thiele, PhD, Ted R. Mikuls, MD, MSPH, Bryant R. England, MD, PhD: VA Nebraska–Western Iowa Health Care System and University of Nebraska Medical Center, Omaha
| | - Bryant R. England
- Ariadne V. Ebel, DO, Jill A. Poole, MD, Geoffrey M. Thiele, PhD, Ted R. Mikuls, MD, MSPH, Bryant R. England, MD, PhD: VA Nebraska–Western Iowa Health Care System and University of Nebraska Medical Center, Omaha
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21
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Bax CE, Maddukuri S, Ravishankar A, Pappas-Taffer L, Werth VP. Environmental triggers of dermatomyositis: a narrative review. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:434. [PMID: 33842655 PMCID: PMC8033368 DOI: 10.21037/atm-20-3719] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Dermatomyositis (DM) is an autoimmune disease that affects the skin, lungs, and muscle. Although the pathogenesis of DM is not completely understood, several environmental triggers have been linked to DM onset or flare. This article specifically examines the effects of herbal supplements, drugs, infections, ultraviolet (UV) radiation, and environmental pollutants on the onset or exacerbation of DM. Herbal supplements such as Spirulina platensis, Aphanizomenon flos-aquae, Chlorella, Echinacea, and Alfalfa have been implicated and are frequently used in health foods. Medications such as hydroxyurea, TNF-α inhibitors, immune checkpoint inhibitors (ICI), and penicillamine, as well as certain viral infections, such as parvovirus B19, coxsackie virus, polyomavirus, Epstein-Barr virus (EBV), hepatitis, influenza, and human immunodeficiency viruses (HIV) have been associated with DM onset. Bacterial infections and vaccinations have also been linked to the development of DM. Additional environmental factors, including UV radiation and air pollutants, such as silica, biological/mineral dust, and particulate air matter from vehicle and industrial emissions, may also play a role in DM pathogenesis. Overall, there is general agreement that an autoimmune attack of the skin, muscle, and lungs in DM can be triggered by various environmental factors and warrants further investigation.
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Affiliation(s)
- Christina E Bax
- Corporal Michael J. Crescenz VAMC, Philadelphia, PA, USA.,Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Spandana Maddukuri
- Corporal Michael J. Crescenz VAMC, Philadelphia, PA, USA.,Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Adarsh Ravishankar
- Corporal Michael J. Crescenz VAMC, Philadelphia, PA, USA.,Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Lisa Pappas-Taffer
- Corporal Michael J. Crescenz VAMC, Philadelphia, PA, USA.,Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Victoria P Werth
- Corporal Michael J. Crescenz VAMC, Philadelphia, PA, USA.,Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
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22
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Inhalants other than personal cigarette smoking and risk for developing rheumatoid arthritis. Curr Opin Rheumatol 2021; 32:279-288. [PMID: 32141952 DOI: 10.1097/bor.0000000000000705] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW The current review summarizes the current evidence on inhalants other than personal cigarette smoking and risk for developing rheumatoid arthritis (RA). RECENT FINDINGS Personal cigarette smoking has been implicated as an environmental risk factor for seropositive RA, perhaps by inducing autoimmunity at pulmonary mucosa. Since many patients with RA are nonsmokers, other inhalants are being investigated as potential RA risk factors. Recent case-control and cohort studies have investigated passive cigarette smoking, air pollution, inhalant-related occupations, silica, pesticides, household environment, and allergic inhalants as inhalant exposures for RA risk. Inhalant-related occupations and silica inhalants have the most consistent evidence for associations with increased RA risk. However, most studies relied on retrospective designs and had limited ability to adjust for personal cigarette smoking or investigate associations among nonsmokers. SUMMARY Several inhalants other than personal cigarette smoking may be associated with increased risk for developing RA. These results support the hypothesis that inhalants, pulmonary mucosal inflammation, and RA pathogenesis may be linked. Future studies are needed to firmly establish the independence of these findings from personal cigarette smoking and to determine the specific inhalants and biologic mechanisms related to RA pathogenesis.
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23
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Boudigaard SH, Schlünssen V, Vestergaard JM, Søndergaard K, Torén K, Peters S, Kromhout H, Kolstad HA. Occupational exposure to respirable crystalline silica and risk of autoimmune rheumatic diseases: a nationwide cohort study. Int J Epidemiol 2021; 50:1213-1226. [PMID: 33462590 PMCID: PMC8407872 DOI: 10.1093/ije/dyaa287] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Indexed: 01/18/2023] Open
Abstract
Background Exposure to respirable crystalline silica is suggested to increase the risk of autoimmune rheumatic diseases. We examined the association between respirable crystalline silica exposure and systemic sclerosis, rheumatoid arthritis, systemic lupus erythematosus and small vessel vasculitis. Methods In a cohort study of the total Danish working population, we included 1 541 505 male and 1 470 769 female workers followed since entering the labour market 1979–2015. Each worker was annually assigned a level of respirable crystalline silica exposure estimated with a quantitative job exposure matrix. We identified cases of autoimmune rheumatic diseases in a national patient register and examined sex-specific exposure-response relations by cumulative exposure and other exposure metrics. Results We identified 4673 male and 12 268 female cases. Adjusted for age and calendar year, men exposed to high levels of respirable crystalline silica compared with non-exposed showed increased incidence rate ratio (IRR) for the four diseases combined of 1.53 [95% confidence interval (CI): 1.39–1.69], for systemic sclerosis of 1.62 (1.08–2.44) and rheumatoid arthritis of 1.57 (1.41–1.75). The overall risk increased with increasing cumulative exposure attained since entering the workforce [IRR: 1.07 (1.05–1.09) per 50 µg/m3-years]. Female workers were less exposed to respirable crystalline silica, but showed comparable risk patterns with overall increased risk with increasing cumulative exposure [IRR: 1.04 (0.99–1.10) per 50 µg/m3-years]. Conclusions This study shows an exposure-dependent association between occupational exposure to respirable crystalline silica and autoimmune rheumatic diseases and thus suggests causal effects, most evident for systemic sclerosis and rheumatoid arthritis.
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Affiliation(s)
- Signe Hjuler Boudigaard
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Vivi Schlünssen
- Department of Public Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark.,National Research Center for the Working Environment, Copenhagen, Denmark
| | - Jesper Medom Vestergaard
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Klaus Søndergaard
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Kjell Torén
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Goteborg, Goteborg, Sweden
| | - Susan Peters
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Hans Kromhout
- Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Henrik A Kolstad
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark
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24
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Altundaş Hatman E, Acar Karagül D, Kılıçaslan Z. Rheumatological Diseases in Denim Sandblasters with Silicosis: What Should Pulmonologists Look for? Turk Thorac J 2020; 21:446-450. [PMID: 33352101 DOI: 10.5152/turkthoracj.2019.19055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 08/31/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Silica exposure is not only the cause of silicosis, also associated rheumatological diseases like rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and systemic sclerosis (SSc). This report will reveal the rheumatological diseases of silicosis patients who were exposed to silica while working as denim sandblasters. Additionally, we will describe some clinical and laboratory findings that will help pulmonologist suspect, recognize and manage rheumatological diseases related to silica exposure in patients with silicosis. MATERIAL AND METHODS We reviewed the records of 142 sandblasters diagnosed with silicosis and found ten silicosis cases who also had rheumatological diseases between the years 2009 and 2017. The occupational characteristics, serological, functional and radiological data, were collected for patients of silicosis with rheumatological diseases. RESULTS Ten silicosis patients with concomitant rheumatological diseases were found. Six patients among our cases had diagnosed SSc (4.2%), three of them had RA (2.1%), and one of them was being monitored for SLE (0.7%). The mean silica exposure time of the cases was 4.3±1.9 years (min: 1 max: 8). We also found elevated LD, sedimentation and CRP levels in our cases. CONCLUSION It should be kept in mind that, in silicosis cases with arthralgia, joint tenderness or sclerosis at the fingertips may be indicative of rheumatological diseases related to silica exposure, and in these cases, the unexplained elevations of sedimentation and CRP levels may also be a result of silica-induced rheumatological diseases.
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Affiliation(s)
- Elif Altundaş Hatman
- Department of Occupational Medicine, İstanbul Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul, Turkey
| | - Duygu Acar Karagül
- Department of Public Health, Occupational Health Training Programme, İstanbul University School of Medicine, İstanbul, Turkey
| | - Zeki Kılıçaslan
- Department of Pulmonary Medicine, İstanbul University School of Medicine, İstanbul, Turkey
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25
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Salliot C, Nguyen Y, Boutron-Ruault MC, Seror R. Environment and Lifestyle: Their Influence on the Risk of RA. J Clin Med 2020; 9:jcm9103109. [PMID: 32993091 PMCID: PMC7601336 DOI: 10.3390/jcm9103109] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 09/22/2020] [Accepted: 09/22/2020] [Indexed: 12/23/2022] Open
Abstract
Background: Rheumatoid arthritis (RA) is a complex disease in which environmental agents are thought to interact with genetic factors that lead to triggering of autoimmunity. Methods: We reviewed environmental, hormonal, and dietary factors that have been suggested to be associated with the risk of RA. Results: Smoking is the most robust factor associated with the risk of RA, with a clear gene–environment interaction. Among other inhalants, silica may increase the risk of RA in men. There is less evidence for pesticides, pollution, and other occupational inhalants. Regarding female hormonal exposures, there is some epidemiological evidence, although not consistent in the literature, to suggest a link between hormonal factors and the risk of RA. Regarding dietary factors, available evidence is conflicting. A high consumption of coffee seems to be associated with an increased risk of RA, whereas a moderate consumption of alcohol is inversely associated with the risk of RA, and there is less evidence regarding other food groups. Dietary pattern analyses (Mediterranean diet, the inflammatory potential of the diet, or diet quality) suggested a potential benefit of dietary modifications for individuals at high risk of RA. Conclusion: To date, smoking and silica exposure have been reproducibly demonstrated to trigger the emergence of RA. However, many other environmental factors have been studied, mostly with a case-control design. Results were conflicting and studies rarely considered potential gene–environment interactions. There is a need for large scale prospective studies and studies in predisposed individuals to better understand and prevent the disease and its course.
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Affiliation(s)
- Carine Salliot
- Centre for Research in Epidemiology and Population Health, (CESP), INSERM U1018, Université Paris-Sud, F-94800 Villejuif, France; (C.S.); (Y.N.); (M.-C.B.-R.)
- Rheumatology Department, Centre Hospitalier Régional d’Orléans, 45100 Orléans, France
- Centre of Immunology of Viral Infections and Auto-immune Diseases (IMVA), INSERM U1184, Université Paris-Sud, F-94270 Le Kremlin Bicêtre, France
| | - Yann Nguyen
- Centre for Research in Epidemiology and Population Health, (CESP), INSERM U1018, Université Paris-Sud, F-94800 Villejuif, France; (C.S.); (Y.N.); (M.-C.B.-R.)
- Department of Internal Medicine, AP-HP. Nord, Hôpital Beaujon, Université de Paris, F-92100 Clichy, France
| | - Marie-Christine Boutron-Ruault
- Centre for Research in Epidemiology and Population Health, (CESP), INSERM U1018, Université Paris-Sud, F-94800 Villejuif, France; (C.S.); (Y.N.); (M.-C.B.-R.)
| | - Raphaèle Seror
- Centre of Immunology of Viral Infections and Auto-immune Diseases (IMVA), INSERM U1184, Université Paris-Sud, F-94270 Le Kremlin Bicêtre, France
- Rheumatology Department, AP-HP, Hôpitaux universitaires Paris-Saclay—Hôpital Bicêtre, F-94270 Le Kremlin Bicêtre, France
- Correspondence: ; Tel.: +33(0)145-213-759
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26
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Sigurdardottir V, Jacobsson L, Schiöler L, Svärd A, Dehlin M, Toren K. Occupational exposure to inorganic dust and risk of gout: a population-based study. RMD Open 2020; 6:rmdopen-2020-001178. [PMID: 32683325 PMCID: PMC7425113 DOI: 10.1136/rmdopen-2020-001178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 05/04/2020] [Accepted: 06/07/2020] [Indexed: 11/24/2022] Open
Abstract
Background Risk factors operating independently of hyperuricemia could be of importance in determining why only a minority of people with hyperuricemia develop gout. Exposure to inorganic dust has been linked to other inflammatory diseases and could influence the development of gout. Objectives To evaluate if occupational exposure to inorganic dust increases the risk of gout. Methods Individuals aged 30–65 years with a first gout diagnosis in 2006–2012 in the population-based healthcare database of the Western Swedish Healthcare Region (VEGA) and population controls matched by age and sex were included. Data on occupation was collected from the Swedish occupational register. Exposure status was assigned by means of a job exposure matrix. Data on gout-related comorbidities was collected from VEGA. Alcohol use disorder and obesity were related both to gout and exposure to inorganic dust and were adjusted for in multivariate analyses. ORs were calculated using conditional logistic regression. Results 5042 gout cases and 20 682 controls were included. Exposure to inorganic dust was associated with gout in both unadjusted (OR 1.12, 95% CI 1.04 to 1.20) and multivariate (OR 1.08, 95% CI 1.00 to 1.16) analyses of the whole population. In sex-stratified multivariate analyses, dust exposure was significantly associated with gout in women (adjusted OR 1.26, 95% CI 1.05 to 1.51), but not in men (adjusted OR 1.05, 95% CI 0.97 to 1.13). Conclusions We describe for the first time an association between exposure to inorganic dust and gout. After adjusting for confounders, the findings were statistically significant for women but not for men.
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Affiliation(s)
- Valgerdur Sigurdardottir
- Department of Rheumatology and Inflammation Research, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden .,Center for Clinical Research Dalarna, Uppsala University, Falun, Sweden
| | - Lennart Jacobsson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Linus Schiöler
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
| | - Anna Svärd
- Center for Clinical Research Dalarna, Uppsala University, Falun, Sweden
| | - Mats Dehlin
- Department of Rheumatology and Inflammation Research, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Kjell Toren
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
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27
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Jonsson E, Järvholm B, Andersson M. Silica dust and sarcoidosis in Swedish construction workers. Occup Med (Lond) 2020; 69:482-486. [PMID: 31504840 PMCID: PMC6913734 DOI: 10.1093/occmed/kqz118] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background The aetiology of sarcoidosis is not well established. In previous studies, smoking has been negatively associated with sarcoidosis and there are some indications of an association between exposure to silica dust and sarcoidosis. Aims To study the risk of sarcoidosis in relation to silica dust exposure. Methods A longitudinal cohort of construction workers linked with a registry of Swedish inpatient diagnoses. Workers were designated as exposed or unexposed to silica based on job titles in a job–exposure matrix. The relative risk (RR) was analysed with Poisson regression adjusting for age and smoking. Results We identified 371 cases of sarcoidosis among 297 917 male workers. There was an increased risk of sarcoidosis in the medium- to high-exposure group [RR 1.83 (95% confidence interval {CI} 1.14–2.95)]. A stratified analysis according to smoking showed that ever-smoking workers had an increased risk of sarcoidosis if highly exposed to silica dust [RR 2.44 (95% CI 1.37–4.33)] compared to non-exposed ever-smokers. The risk of non-smokers highly exposed to silica was not significantly increased [RR 1.07 (95% CI 0.72–1.58)] compared to non-exposed non-smokers. Conclusion The study indicates an increased risk of developing sarcoidosis in ever-smoking men exposed to silica.
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Affiliation(s)
- E Jonsson
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden
| | - B Järvholm
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden
| | - M Andersson
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden
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28
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Mehri F, Jenabi E, Bashirian S, Shahna FG, Khazaei S. The association Between Occupational Exposure to silica and Risk of Developing Rheumatoid Arthritis: A Meta-Analysis. Saf Health Work 2020; 11:136-142. [PMID: 32596007 PMCID: PMC7303526 DOI: 10.1016/j.shaw.2020.02.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 01/31/2020] [Accepted: 02/22/2020] [Indexed: 02/06/2023] Open
Abstract
Background Rheumatoid arthritis (RA) is an autoimmune disease with systemic inflammatory arthritis. This meta-analysis was conducted to examine the association between occupational exposure to silica and the risk of developing RA among different workers. Methods In this meta-analysis, we searched relevant published studies using major electronic databases including Scopus, PubMed, ISI Web of Science, and Google Scholar search engine up to October 2019, and the references of retrieved articles were also checked for further possible sources. A random-effects model was used to account for heterogeneity among the results of the studies using the pooled odds ratios (ORs) and their 95% confidence intervals (CIs). The Q-statistic and I2 tests were calculated to assess heterogeneity between the studies. Results The pooled calculation of OR indicated a significant association between occupational exposure to silica and risk of developing RA among different workers (OR = 2.59, 95% CI = 1.73 to 3.45). In addition, the pooled estimates of OR in smokers were statistically significant (OR = 2.49, 95% CI = 1.13 to 3.86). Conclusions The findings of the present study reveal that occupational exposure to silica may be associated with increased risk of developing RA.
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Affiliation(s)
- Fereshteh Mehri
- Department of Nutritional Sciences, Nutrition Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ensiyeh Jenabi
- Department of Nursing & Midwifery, Autism Spectrum Disorders Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Saeed Bashirian
- Department of Public Health, Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Farshid Ghorbani Shahna
- Department of Occupational Health, Occupational Health and Safety Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Salman Khazaei
- Department of Epidemiology, Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
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29
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Ishikawa Y, Terao C. The Impact of Cigarette Smoking on Risk of Rheumatoid Arthritis: A Narrative Review. Cells 2020; 9:cells9020475. [PMID: 32092988 PMCID: PMC7072747 DOI: 10.3390/cells9020475] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 12/13/2022] Open
Abstract
Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic inflammation and subsequent proliferation of synovial tissues, which eventually leads to cartilage and bone destruction without effective treatments. Anti-citrullinated cyclic peptide/protein antibody (ACPA) and rheumatoid factor (RF) are two main characteristic autoantibodies found in RA patients and are associated with unfavorable disease outcomes. Although etiologies and causes of the disease have not been fully clarified yet, it is likely that interactive contributions of genetic and environmental factors play a main role in RA pathology. Previous works have demonstrated several genetic and environmental factors as risks of RA development and/or autoantibody productions. Among these, cigarette smoking and HLA-DRB1 are the well-established environmental and genetic risks, respectively. In this narrative review, we provide a recent update on genetic contributions to RA and the environmental risks of RA with a special focus on cigarette smoking and its impacts on RA pathology. We also describe gene–environmental interaction in RA pathogenesis with an emphasis on cigarette smoking and HLA-DRB1.
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Affiliation(s)
- Yuki Ishikawa
- Section for Immunobiology, Joslin Diabetes Center, Harvard Medical School, One Joslin Place, Boston, MA 02215, USA;
- Laboratory for Statistical and Translational Genetics, Center for Integrative Medical Sciences, RIKEN, 1-7-22 Suehiro-cho, Tsurumi-ku, Yokohama, Kanagawa 230-0045, Japan
| | - Chikashi Terao
- Laboratory for Statistical and Translational Genetics, Center for Integrative Medical Sciences, RIKEN, 1-7-22 Suehiro-cho, Tsurumi-ku, Yokohama, Kanagawa 230-0045, Japan
- Clinical Research Center, Shizuoka General Hospital, 4 Chome-27-1 Kitaando, Aoi Ward, Shizuoka 420-8527, Japan
- Department of Applied Genetics, The School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka 422-8526, Japan
- Correspondence: ; Tel.: +81-(0)45-503-9121
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30
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Lescoat A, Ballerie A, Lelong M, Augagneur Y, Morzadec C, Jouneau S, Jégo P, Fardel O, Vernhet L, Lecureur V. Crystalline Silica Impairs Efferocytosis Abilities of Human and Mouse Macrophages: Implication for Silica-Associated Systemic Sclerosis. Front Immunol 2020; 11:219. [PMID: 32133004 PMCID: PMC7039938 DOI: 10.3389/fimmu.2020.00219] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 01/27/2020] [Indexed: 12/14/2022] Open
Abstract
Inhalation of crystalline silica (SiO2) is a risk factor of systemic autoimmune diseases such as systemic sclerosis (SSc) and fibrotic pulmonary disorders such as silicosis. A defect of apoptotic cell clearance (i.e., efferocytosis, a key process in the resolution of inflammation) is reported in macrophages from patients with fibrotic or autoimmune diseases. However, the precise links between SiO2 exposure and efferocytosis impairment remain to be determined. Answering to this question may help to better link innate immunity and fibrosis. In this study, we first aim to determine whether SiO2 might alter efferocytosis capacities of human and mouse macrophages. We secondly explore possible mechanisms explaining efferocytosis impairment, with a specific focus on macrophage polarization and on the RhoA/ROCK pathway, a key regulator of cytoskeleton remodeling and phagocytosis. Human monocyte-derived macrophages (MDM) and C57BL/6J mice exposed to SiO2 and to CFSE-positive apoptotic Jurkat cells were analyzed by flow cytometry to determine their efferocytosis index (EI). The effects of ROCK inhibitors (Y27632 and Fasudil) on EI of SiO2-exposed MDM and MDM from SSc patients were evaluated in vitro. Our results demonstrated that SiO2 significantly decreased EI of human MDM in vitro and mouse alveolar macrophages in vivo. In human MDM, this SiO2-associated impairment of efferocytosis, required the expression of the membrane receptor SR-B1 and was associated with a decreased expression of M2 polarization markers (CD206, CD204, and CD163). F-actin staining, RhoA activation and impairment of efferocytosis, all induced by SiO2, were reversed by ROCK inhibitors. Moreover, the EI of MDM from SSc patients was similar to the EI of in vitro- SiO2-exposed MDM and Y27632 significantly increased SSc MDM efferocytosis capacities, suggesting a likewise activation of the RhoA/ROCK pathway in SSc. Altogether, our results demonstrate that SiO2 exposure may contribute to the impairment of efferocytosis capacities of mouse and human macrophages but also of MDM in SiO2-associated autoimmune diseases and fibrotic disorders such as SSc; in this context, the silica/RhoA/ROCK pathway may constitute a relevant therapeutic target.
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Affiliation(s)
- Alain Lescoat
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) – UMR_S 1085, Rennes, France
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, Rennes, France
| | - Alice Ballerie
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) – UMR_S 1085, Rennes, France
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, Rennes, France
| | - Marie Lelong
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) – UMR_S 1085, Rennes, France
| | - Yu Augagneur
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) – UMR_S 1085, Rennes, France
| | - Claudie Morzadec
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) – UMR_S 1085, Rennes, France
| | - Stéphane Jouneau
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) – UMR_S 1085, Rennes, France
- Department of Respiratory Diseases, Rennes University Hospital, Rennes, France
| | - Patrick Jégo
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) – UMR_S 1085, Rennes, France
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, Rennes, France
| | - Olivier Fardel
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) – UMR_S 1085, Rennes, France
- Pôle Biologie, Rennes University Hospital, Rennes, France
| | - Laurent Vernhet
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) – UMR_S 1085, Rennes, France
| | - Valérie Lecureur
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) – UMR_S 1085, Rennes, France
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Ying D, Gianfrancesco MA, Trupin L, Yazdany J, Greidinger EL, Schmajuk G. Increased Risk of Ischemic Stroke in Systemic Sclerosis: A National Cohort Study of US Veterans. J Rheumatol 2020; 47:82-88. [PMID: 30877213 PMCID: PMC7269199 DOI: 10.3899/jrheum.181311] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Previously thought to involve primarily the microvasculature, systemic sclerosis (SSc) has been increasingly linked to macrovascular disease. Cardiovascular (CV) and cerebrovascular disease are responsible for 20-30% of mortality in SSc, but few studies have shown an independent association between SSc and stroke. We assessed whether SSc was an independent risk factor for ischemic stroke. METHODS We conducted a retrospective cohort study using the national Veterans Affairs (VA) administrative database containing records from 1999 to 2014. We obtained data for all patients with a diagnosis of SSc as well as 2 controls per SSc patient matched on sex, race, smoking status, and VA site. All patients were followed until development of ischemic stroke, death, or last encounter. We used a Cox proportional hazard regression model to estimate risk of ischemic stroke, with adjustments for CV comorbidities (hypertension, diabetes, atrial fibrillation, non-cerebrovascular atherosclerotic disease, hyperlipidemia), baseline medication use (aspirin, nonsteroidal antiinflammatory drugs), and Medicare enrollment. RESULTS Among 4545 individuals with SSc (83% male, mean age 60.9 yrs), the incidence rate of ischemic stroke was 15.3 per 1000 person-years (vs 12.2 in the control cohort), with an unadjusted HR 1.28 (95% CI 1.11-1.47). The adjusted HR was 1.21 (95% CI 1.05-1.40) after adjusting for baseline CV risk factors, medications, and Medicare enrollment. CONCLUSION SSc is independently associated with a higher risk of ischemic stroke among US veterans. Patients with SSc represent a population likely to benefit from targeted stroke screening or prevention therapies.
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Affiliation(s)
- David Ying
- From the San Francisco Veterans Affairs Medical Center, San Francisco; Division of Rheumatology, University of California, San Francisco, California; Miami Veterans Affairs Medical Center, Miami; Division of Rheumatology, University of Miami Miller School of Medicine, Miami, Florida, USA.
- D. Ying, MD, San Francisco Veterans Affairs Medical Center, and Division of Rheumatology, University of California, San Francisco; M.A. Gianfrancesco, PhD, MPH, Division of Rheumatology, University of California, San Francisco; L. Trupin, MPH, Division of Rheumatology, University of California, San Francisco; J. Yazdany, MD, MPH, Division of Rheumatology, University of California, San Francisco; E.L. Greidinger, MD, Miami Veterans Affairs Medical Center, and Division of Rheumatology, University of Miami Miller School of Medicine; G. Schmajuk, MD, MS, San Francisco Veterans Affairs Medical Center, and Division of Rheumatology, University of California, San Francisco. E.L. Greidinger and G. Schmajuk contributed equally to this work.
| | - Milena A Gianfrancesco
- From the San Francisco Veterans Affairs Medical Center, San Francisco; Division of Rheumatology, University of California, San Francisco, California; Miami Veterans Affairs Medical Center, Miami; Division of Rheumatology, University of Miami Miller School of Medicine, Miami, Florida, USA
- D. Ying, MD, San Francisco Veterans Affairs Medical Center, and Division of Rheumatology, University of California, San Francisco; M.A. Gianfrancesco, PhD, MPH, Division of Rheumatology, University of California, San Francisco; L. Trupin, MPH, Division of Rheumatology, University of California, San Francisco; J. Yazdany, MD, MPH, Division of Rheumatology, University of California, San Francisco; E.L. Greidinger, MD, Miami Veterans Affairs Medical Center, and Division of Rheumatology, University of Miami Miller School of Medicine; G. Schmajuk, MD, MS, San Francisco Veterans Affairs Medical Center, and Division of Rheumatology, University of California, San Francisco. E.L. Greidinger and G. Schmajuk contributed equally to this work
| | - Laura Trupin
- From the San Francisco Veterans Affairs Medical Center, San Francisco; Division of Rheumatology, University of California, San Francisco, California; Miami Veterans Affairs Medical Center, Miami; Division of Rheumatology, University of Miami Miller School of Medicine, Miami, Florida, USA
- D. Ying, MD, San Francisco Veterans Affairs Medical Center, and Division of Rheumatology, University of California, San Francisco; M.A. Gianfrancesco, PhD, MPH, Division of Rheumatology, University of California, San Francisco; L. Trupin, MPH, Division of Rheumatology, University of California, San Francisco; J. Yazdany, MD, MPH, Division of Rheumatology, University of California, San Francisco; E.L. Greidinger, MD, Miami Veterans Affairs Medical Center, and Division of Rheumatology, University of Miami Miller School of Medicine; G. Schmajuk, MD, MS, San Francisco Veterans Affairs Medical Center, and Division of Rheumatology, University of California, San Francisco. E.L. Greidinger and G. Schmajuk contributed equally to this work
| | - Jinoos Yazdany
- From the San Francisco Veterans Affairs Medical Center, San Francisco; Division of Rheumatology, University of California, San Francisco, California; Miami Veterans Affairs Medical Center, Miami; Division of Rheumatology, University of Miami Miller School of Medicine, Miami, Florida, USA
- D. Ying, MD, San Francisco Veterans Affairs Medical Center, and Division of Rheumatology, University of California, San Francisco; M.A. Gianfrancesco, PhD, MPH, Division of Rheumatology, University of California, San Francisco; L. Trupin, MPH, Division of Rheumatology, University of California, San Francisco; J. Yazdany, MD, MPH, Division of Rheumatology, University of California, San Francisco; E.L. Greidinger, MD, Miami Veterans Affairs Medical Center, and Division of Rheumatology, University of Miami Miller School of Medicine; G. Schmajuk, MD, MS, San Francisco Veterans Affairs Medical Center, and Division of Rheumatology, University of California, San Francisco. E.L. Greidinger and G. Schmajuk contributed equally to this work
| | - Eric L Greidinger
- From the San Francisco Veterans Affairs Medical Center, San Francisco; Division of Rheumatology, University of California, San Francisco, California; Miami Veterans Affairs Medical Center, Miami; Division of Rheumatology, University of Miami Miller School of Medicine, Miami, Florida, USA
- D. Ying, MD, San Francisco Veterans Affairs Medical Center, and Division of Rheumatology, University of California, San Francisco; M.A. Gianfrancesco, PhD, MPH, Division of Rheumatology, University of California, San Francisco; L. Trupin, MPH, Division of Rheumatology, University of California, San Francisco; J. Yazdany, MD, MPH, Division of Rheumatology, University of California, San Francisco; E.L. Greidinger, MD, Miami Veterans Affairs Medical Center, and Division of Rheumatology, University of Miami Miller School of Medicine; G. Schmajuk, MD, MS, San Francisco Veterans Affairs Medical Center, and Division of Rheumatology, University of California, San Francisco. E.L. Greidinger and G. Schmajuk contributed equally to this work
| | - Gabriela Schmajuk
- From the San Francisco Veterans Affairs Medical Center, San Francisco; Division of Rheumatology, University of California, San Francisco, California; Miami Veterans Affairs Medical Center, Miami; Division of Rheumatology, University of Miami Miller School of Medicine, Miami, Florida, USA
- D. Ying, MD, San Francisco Veterans Affairs Medical Center, and Division of Rheumatology, University of California, San Francisco; M.A. Gianfrancesco, PhD, MPH, Division of Rheumatology, University of California, San Francisco; L. Trupin, MPH, Division of Rheumatology, University of California, San Francisco; J. Yazdany, MD, MPH, Division of Rheumatology, University of California, San Francisco; E.L. Greidinger, MD, Miami Veterans Affairs Medical Center, and Division of Rheumatology, University of Miami Miller School of Medicine; G. Schmajuk, MD, MS, San Francisco Veterans Affairs Medical Center, and Division of Rheumatology, University of California, San Francisco. E.L. Greidinger and G. Schmajuk contributed equally to this work
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Hjuler Boudigaard S, Stokholm ZA, Vestergaard JM, Mohr MS, Søndergaard K, Torén K, Schlünssen V, Kolstad HA. A follow-up study of occupational styrene exposure and risk of autoimmune rheumatic diseases. Occup Environ Med 2019; 77:64-69. [PMID: 31848232 PMCID: PMC7029229 DOI: 10.1136/oemed-2019-106018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 11/18/2019] [Accepted: 11/26/2019] [Indexed: 11/10/2022]
Abstract
Objectives Increased risk has been suggested for autoimmune rheumatic diseases following solvent exposure. The evidence for specific solvents is limited, and little is known about exposure–response relations. Styrene is an aromatic, organic solvent and the objective of this study was to analyse the association between occupational styrene exposure and autoimmune rheumatic diseases in men and women. Methods We followed 72 212 styrene-exposed workers of the Danish reinforced plastics industry from 1979 to 2012. We modelled full work history of styrene exposure from employment history, survey data and historical styrene exposure measurements. We identified cases in the national patient registry and investigated gender-specific exposure–response relations by cumulative styrene exposure for different exposure time windows adjusting for age, calendar year and educational level. Results During 1 515 126 person-years of follow-up, we identified 718 cases of an autoimmune rheumatic disease, of which 73% were rheumatoid arthritis. When adjusting for potential confounders and comparing the highest with the lowest styrene exposure tertile, we observed a statistically non-significantly increased risk of systemic sclerosis among women (incidence rate ratio (IRR)=2.50; 95% CI 0.50 to 12.50) and men (IRR=1.86; 95 % CI 0.50 to 7.00), based on 9 and 22 cases, respectively. Results were inconsistent for the other autoimmune rheumatic diseases examined. Conclusion This study suggests an association between occupational styrene exposure and systemic sclerosis in men as well as in women but based on few cases. This is a new finding and has to be replicated before conclusions can be drawn.
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Affiliation(s)
- Signe Hjuler Boudigaard
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Zara Ann Stokholm
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Jesper Medom Vestergaard
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Mette Skovgaard Mohr
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark.,Centre for Integrated Register-Based Research, CIRRAU, Aarhus Universitet, Aarhus, Denmark
| | - Klaus Søndergaard
- Department of Rheumathology, Aarhus University Hospital, Aarhus, Denmark
| | - Kjell Torén
- Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Vivi Schlünssen
- Department of Public Health, Danish Ramazzini Centre, Aarhus Universitet, Aarhus, Denmark.,National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Henrik A Kolstad
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark.,Centre for Integrated Register-Based Research, CIRRAU, Aarhus Universitet, Aarhus, Denmark
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Ilar A, Gustavsson P, Wiebert P, Alfredsson L. Occupational exposure to organic dusts and risk of developing rheumatoid arthritis: findings from a Swedish population-based case-control study. RMD Open 2019; 5:e001049. [PMID: 31803499 PMCID: PMC6890392 DOI: 10.1136/rmdopen-2019-001049] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 11/04/2019] [Accepted: 11/07/2019] [Indexed: 01/27/2023] Open
Abstract
Objectives We estimated the association between occupational exposures to five different organic dusts: wood, animal, paper, textile and flour dust and the risk of developing rheumatoid arthritis (RA). Methods This population-based case–control study analysed 12 582 incident cases and 129 335 controls. Participants were identified from national public authority and quality registers. Census data on occupations were collected 1960–2010 and we estimated the exposure to organic dust with the help of job-exposure matrices. We used logistic regression to assess the OR of seropositive or seronegative RA. Estimates were adjusted for the matching variables (sex, county, age and index year), education and occupational silica exposure. Results Exposure to animal dust was associated with an increased risk of RA among both men and women. The OR was 1.2 (95% CI=1.1 to 1.4) for seropositive RA and 1.3 (95% CI=1.1 to 1.5) for seronegative RA among ever exposed participants compared with unexposed. The risk increased with duration of exposure for seropositive RA, and participants who had been exposed in five or more censuses had an OR of 1.6 (95% CI=1.1 to 2.2, p for trend=0.003). Exposure to textile dust also generated a significant dose–response relationship for seropositive RA (p for trend=0.014). We detected no association between exposure to wood, paper or flour dust and risk of RA. Conclusions Overall, exposure to animal dust and textile dust was associated with an increased risk of developing RA. These observations give further support to the notion that airborne exposures are involved in the aetiology of RA.
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Affiliation(s)
- Anna Ilar
- Unit of Translational Epidemiology, The Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Per Gustavsson
- Unit of Occupational Medicine, The Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
| | - Pernilla Wiebert
- Unit of Occupational Medicine, The Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
| | - Lars Alfredsson
- Unit of Translational Epidemiology, The Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
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Schmajuk G, Trupin L, Yelin E, Blanc PD. Prevalence of Arthritis and Rheumatoid Arthritis in Coal Mining Counties of the United States. Arthritis Care Res (Hoboken) 2019; 71:1209-1215. [PMID: 30875457 DOI: 10.1002/acr.23874] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 03/05/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Exposure to inhaled mineral dust, in particular silica, is associated with increased odds of rheumatoid arthritis (RA) and other autoimmune diseases. We studied the association of RA with work-related coal and silica exposure in the Appalachian region of the US. METHODS We carried out a random-digit dialed telephone survey in selected counties in Appalachia that had elevated coal workers' pneumoconiosis mortality. Our study cohort included men ages ≥50 with any employment history, and we assessed exposure to coal mining employment, other work-related dust, and ergonomic factors. We ascertained self-reported physician diagnosis of any arthritis and of RA with glucocorticoid treatment. We used multivariable logistic regression analysis to estimate the odds ratios (ORs) and associated population attributable fraction (PAF) estimates. RESULTS Among the 973 men who met study entry criteria (mean ± SD ages 66 ± 10 years; 54% ever smokers), 266 (27%) reported coal mining work and 189 (19%) reported other work-related silica exposure. There were 517 men (53%), who reported any arthritis and 112 (12%) whose disease met the study definition of RA. Adjusting for covariates, coal mining was associated with elevated odds of RA (OR 3.6 [95% confidence interval (95% CI) 2.1-6.2]), which accounted for a PAF of 33% (95% CI 26-40%) of the men studied. For any arthritis, the coal mining-associated OR was 2.3 (95% CI 1.6-3.2), with an associated PAF of 20% (95% CI 14-25%). CONCLUSION In this population of older males living in a coal mining region, we estimated that 20% of arthritis and 33% of RA may be attributable to coal mining work.
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Affiliation(s)
- Gabriela Schmajuk
- University of California, San Francisco and the San Francisco Veterans Affairs Health Care System, San Francisco, California
| | | | | | - Paul D Blanc
- University of California, San Francisco and the San Francisco Veterans Affairs Health Care System, San Francisco, California
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35
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Ilar A, Klareskog L, Saevarsdottir S, Wiebert P, Askling J, Gustavsson P, Alfredsson L. Occupational exposure to asbestos and silica and risk of developing rheumatoid arthritis: findings from a Swedish population-based case-control study. RMD Open 2019; 5:e000978. [PMID: 31413868 PMCID: PMC6667973 DOI: 10.1136/rmdopen-2019-000978] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/24/2019] [Accepted: 06/26/2019] [Indexed: 11/04/2022] Open
Abstract
Objective Airborne agents including cigarette smoke associate with an increased risk of rheumatoid arthritis (RA). We analysed to which extent occupational exposure to asbestos and silica confers an increased risk of developing serologically defined subsets of RA. Methods This Swedish population-based case-control study enrolled incident RA cases between 1996 and 2013 (n=11 285), identified through national public authority and quality registers, as well as from the Epidemiological Investigation of Rheumatoid Arthritis (EIRA) Study. Controls (n=1 15 249) were randomly selected from Sweden’s population register and matched on sex, age, index year and county. Occupational histories were obtained from national censuses. Exposure to asbestos and silica was assessed by job-exposure matrices. Logistic regression was used to calculate ORs adjusted for age, sex, county, index year, alcohol use and smoking. Results Results showed that male workers exposed to asbestos had higher risk of seropositive RA (OR=1.2, 95% CI 1.0 to 1.4) and seronegative RA (OR=1.2, 95% CI 1.0 to 1.5) compared with unexposed workers. The risk was highest among workers exposed to asbestos from 1970, before a national ban was introduced. Male workers exposed to silica also had higher risk of RA (seropositive RA: OR=1.4, 95% CI 1.2 to 1.6; seronegative RA: OR=1.3, 95% CI 1.0 to 1.5). For the largest subset, seropositive RA, the OR increased with the number of years exposed to silica, up to OR=2.3 (95% CI 1.4 to 3.8, p for trend <0.0001). Women overall had lower ORs than men, but the duration and intensity of their exposure were lower. Conclusions In conclusion, we observed an association between asbestos exposure and risk of developing RA and extended previous findings of an association between silica exposure and RA risk, where a dose-response relationship was observed.
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Affiliation(s)
- Anna Ilar
- Unit of Translational Epidemiology, The Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lars Klareskog
- Rheumatology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Saedis Saevarsdottir
- Unit of Translational Epidemiology, The Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Rheumatology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Pernilla Wiebert
- Unit of Occupational Medicine, The Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
| | - Johan Askling
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Rheumatology, Theme Inflammation and Infection, Karolinska University Hospital, Stockholm, Sweden
| | - Per Gustavsson
- Unit of Occupational Medicine, The Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
| | - Lars Alfredsson
- Unit of Translational Epidemiology, The Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
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Lucchino B, Spinelli FR, Iannuccelli C, Guzzo MP, Conti F, Di Franco M. Mucosa-Environment Interactions in the Pathogenesis of Rheumatoid Arthritis. Cells 2019; 8:E700. [PMID: 31295951 PMCID: PMC6678242 DOI: 10.3390/cells8070700] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 07/04/2019] [Accepted: 07/05/2019] [Indexed: 12/15/2022] Open
Abstract
Mucosal surfaces play a central role in the pathogenesis of rheumatoid arthritis (RA). Several risk factors, such as cigarette smoking, environmental pollution, and periodontitis interact with the host at the mucosal level, triggering immune system activation. Moreover, the alteration of microbiota homeostasis is gaining increased attention for its involvement in the disease pathogenesis, modulating the immune cell response at a local and subsequently at a systemic level. Currently, the onset of the clinical manifest arthritis is thought to be the last step of a series of pathogenic events lasting years. The positivity for anti-citrullinated protein antibodies (ACPAs) and rheumatoid factor (RF), in absence of symptoms, characterizes a preclinical phase of RA-namely systemic autoimmune phase- which is at high risk for disease progression. Several immune abnormalities, such as local ACPA production, increased T cell polarization towards a pro-inflammatory phenotype, and innate immune cell activation can be documented in at-risk subjects. Many of these abnormalities are direct consequences of the interaction between the environment and the host, which takes place at the mucosal level. The purpose of this review is to describe the humoral and cellular immune abnormalities detected in subjects at risk of RA, highlighting their origin from the mucosa-environment interaction.
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Affiliation(s)
- Bruno Lucchino
- Rheumatology Unit, Department of Internal Medicine and Medical Specialities, Sapienza University of Rome, 00161 Rome, Italy.
| | - Francesca Romani Spinelli
- Rheumatology Unit, Department of Internal Medicine and Medical Specialities, Sapienza University of Rome, 00161 Rome, Italy
| | - Cristina Iannuccelli
- Rheumatology Unit, Department of Internal Medicine and Medical Specialities, Sapienza University of Rome, 00161 Rome, Italy
| | - Maria Paola Guzzo
- Rheumatology Unit, Department of Internal Medicine and Medical Specialities, Sapienza University of Rome, 00161 Rome, Italy
| | - Fabrizio Conti
- Rheumatology Unit, Department of Internal Medicine and Medical Specialities, Sapienza University of Rome, 00161 Rome, Italy
| | - Manuela Di Franco
- Rheumatology Unit, Department of Internal Medicine and Medical Specialities, Sapienza University of Rome, 00161 Rome, Italy
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Pearson DR, Werth VP. Geospatial Correlation of Amyopathic Dermatomyositis With Fixed Sources of Airborne Pollution: A Retrospective Cohort Study. Front Med (Lausanne) 2019; 6:85. [PMID: 31069228 PMCID: PMC6491706 DOI: 10.3389/fmed.2019.00085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 04/04/2019] [Indexed: 11/28/2022] Open
Abstract
Objective: Dermatomyositis (DM) may result from exogenous triggers, including airborne pollutants, in genetically susceptible individuals. The United States Environmental Protection Agency's 2011 National Air Toxics Assessment (NATA) models health risks associated with airborne emissions, available by ZIP code tabulation area (ZCTA). Important contributors include point (fixed), on-road, and secondary sources. The objective of this study was to investigate the geospatial distributions of DM and subtypes, classic DM (CDM) and clinically amyopathic DM (CADM), and their associations with airborne pollutants. Methods: This retrospective cohort study identified 642 adult DM patients from 336 unique ZCTAs. GeoDa v.1.10 was used to calculate global and local Moran's indices and generate local indicator of spatial autocorrelation (LISA) maps. All Moran's indices and LISA maps were permuted 999 times. Results: Univariate global Moran's indices for DM, CDM, and CADM prevalence were not significant, but LISA maps demonstrated differential local spatial clustering and outliers. CADM prevalence correlated with point sources (bivariate global Moran's index 0.071, pseudo-p = 0.018), in contrast to CDM (−0.0053, pseudo-p = 0.46). Bivariate global Moran's indices for DM, CDM, and CADM prevalence did not correlate with other airborne toxics, but bivariate LISA maps revealed local spatial clustering and outliers. Conclusion: Prevalence of CADM, but not CDM, is geospatially correlated with fixed sources of airborne emissions. This effect is small but significant and may support the hypothesis that triggering exposures influence disease phenotype. Important limitations are NATA data and ZCTA population estimates were collected from 2011 and ZCTA of residence may not have been where patients had greatest airborne pollutant exposure.
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Affiliation(s)
- David R Pearson
- Department of Dermatology, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Victoria P Werth
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, United States.,Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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Murphy D, Bellis K, Hutchinson D. Vapour, gas, dust and fume occupational exposures in male patients with rheumatoid arthritis resident in Cornwall (UK) and their association with rheumatoid factor and anti-cyclic protein antibodies: a retrospective clinical study. BMJ Open 2018; 8:e021754. [PMID: 29773705 PMCID: PMC5961584 DOI: 10.1136/bmjopen-2018-021754] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To quantify exposure to vapour, gas, dust and fumes (VGDF) and smoking in male rheumatoid arthritis (RA) and investigate impact on rheumatoid factor (RF) and anti-citrullinated protein antibody (ACPA) levels. DESIGN A retrospective observational study. SETTING The Royal Cornwall Hospital Trust, UK. A single university hospital setting. PARTICIPANTS 726 men followed up between February 2015 and August 2016, fulfilling RA diagnostic criteria. MAIN OUTCOME MEASURES Prevalence of VGDF exposure and smoking prior to RA diagnosis. Determination of association between VGDF, smoking and autoantibody levels. RESULTS 546/726 (75%) had been exposed to VGDF for >1 year. 561/726 (77%) had been smokers. Only 58/726 (8%) had no exposure to VGDF and had never smoked. A significant difference in RF levels was observed between unexposed and VGDF exposed never smokers (median RF 24 vs 36, p=0.03), more marked when comparing unexposed with ≥2 VGDF exposures (median RF 24 vs 57, p=0.02). A significant difference in RF levels was also observed between unexposed and VGDF exposed smokers (median RF 71 vs RF 95, p=0.04), more marked when comparing unexposed with ≥2 VGDF exposures (median RF 71 vs RF 113, p=0.01). A significant difference in RF titre was observed between never smokers >2 VGDF exposures and smokers with >2 VGDF exposures (RF 57 vs RF 113, p=0.02). No association of ACPA seropositivity rates or titres with VGDF exposure was observed. Smokers with >2 VGDF exposures had a significantly lower age of RA diagnosis than smokers with no VGDF exposure (53 years vs 57 years, p=0.03). All results remained similar when corrected for social class. CONCLUSIONS VGDF exposure increases RF levels. Combination exposure to smoking and VDGF results in higher RF levels, particularly with multiple exposures. These compelling findings demonstrate the importance of combined inhaled exposures in RF generation.
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Affiliation(s)
- Dan Murphy
- Rheumatology Department, Royal Cornwall Hospital, Truro, Cornwall, UK
- University of Exeter Medical School Cornwall Campus, Royal Cornwall Hospital, Knowledge Spa, Truro, Cornwall, UK
| | - Katy Bellis
- Rheumatology Department, Royal Cornwall Hospital, Truro, Cornwall, UK
| | - David Hutchinson
- Rheumatology Department, Royal Cornwall Hospital, Truro, Cornwall, UK
- University of Exeter Medical School Cornwall Campus, Royal Cornwall Hospital, Knowledge Spa, Truro, Cornwall, UK
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Ilar A, Alfredsson L, Wiebert P, Klareskog L, Bengtsson C. Occupation and Risk of Developing Rheumatoid Arthritis: Results From a Population-Based Case-Control Study. Arthritis Care Res (Hoboken) 2018; 70:499-509. [DOI: 10.1002/acr.23321] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 07/11/2017] [Indexed: 12/13/2022]
Affiliation(s)
- Anna Ilar
- Karolinska Institutet; Stockholm Sweden
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High prevalence of occupational exposure to solvents or silica in male systemic sclerosis patients: a Belgian cohort analysis. Clin Rheumatol 2018; 37:1977-1982. [DOI: 10.1007/s10067-018-4045-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 02/11/2018] [Accepted: 02/15/2018] [Indexed: 01/19/2023]
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Zheng H, Högberg J, Stenius U. ATM-activated autotaxin (ATX) propagates inflammation and DNA damage in lung epithelial cells: a new mode of action for silica-induced DNA damage? Carcinogenesis 2017; 38:1196-1206. [PMID: 28968864 DOI: 10.1093/carcin/bgx100] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 09/12/2017] [Indexed: 12/17/2022] Open
Abstract
Silica exposure is a common risk factor for lung cancer. It has been claimed that key elements in cancer development are activation of inflammatory cells that indirectly induce DNA damage and proliferative stimuli in respiratory epithelial cells. We studied DNA damage induced by silica particles in respiratory epithelial cells and focused the role of the signaling enzyme autotaxin (ATX). A549 and 16 bronchial epithelial cells (16HBE) lung epithelial cells were exposed to silica particles. Reactive oxygen species (ROS), NOD-like receptor family pyrin domain containing-3 (NLRP3) inflammasome activation, ATX, ataxia telangiectasia mutated (ATM), and DNA damage (γH2AX, pCHK1, pCHK2, comet assay) were end points. Low doses of silica induced NLRP3 activation, DNA damage accumulation, and ATM phosphorylation. A novel finding was that ATM induced ATX generation and secretion. Not only silica but also rotenone, camptothecin and H2O2 activated ATX via ATM, suggesting that ATX is part of a generalized ATM response to double-strand breaks (DSBs). Surprisingly, ATX inhibition mitigated DNA damage accumulation at later time points (6-16 h), and ATX transfection caused NLRP3 activation and DNA damage. Furthermore, the product of ATX enzymatic activity, lysophosphatidic acid, recapitulated the effects of ATX transfection. These data indicate an ATM-ATX-dependent loop that propagates inflammation and DSB accumulation, making low doses of silica effective inducers of DSBs in epithelial cells. We conclude that an ATM-ATX axis interconnects DSBs with silica-induced inflammation and propagates these effects in epithelial cells. Further studies of this adverse outcome pathway may give an accurate assessment of the lowest doses of silica that causes cancer.
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Affiliation(s)
- Huiyuan Zheng
- Institute of Environmental Medicine, Karolinska Institutet Box 210, Sweden
| | - Johan Högberg
- Institute of Environmental Medicine, Karolinska Institutet Box 210, Sweden
| | - Ulla Stenius
- Institute of Environmental Medicine, Karolinska Institutet Box 210, Sweden
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42
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Murphy D, Hutchinson D. Is Male Rheumatoid Arthritis an Occupational Disease? A Review. Open Rheumatol J 2017; 11:88-105. [PMID: 28932330 PMCID: PMC5585464 DOI: 10.2174/1874312901711010088] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 06/21/2017] [Accepted: 07/09/2017] [Indexed: 11/24/2022] Open
Abstract
Background: Rheumatoid arthritis (RA) is a systemic, inflammatory disease with an estimated global prevalence of 0.3–1.0%. An unexplained association exists between low formal education and the development of RA independent of smoking. It is established that RA is initiated in the lungs and that various occupations associated with dust, fume and metal inhalation can increase the risk of RA development. Objective: The objective of this review is to evaluate published clinical reports related to occupations associated with RA development. We highlight the concept of a “double-hit” phenomenon involving adsorption of toxic metals from cigarette smoke by dust residing in the lung as a result of various work exposures. We discuss the relevant pathophysiological consequences of these inhalational exposures in relation to RA associated autoantibody production. Method: A thorough literature search was performed using available databases including Pubmed, Embase, and Cochrane database to cover all relative reports, using combinations of keywords: rheumatoid arthritis, rheumatoid factor, anti-citrullinated peptide antibody silica, dust, fumes, metals, cadmium, cigarette smoking, asbestos, mining, bronchial associated lymphoid tissue, heat shock protein 70, and adsorption. Conclusion: We postulate that the inhalation of dust, metals and fumes is a significant trigger factor for RA development in male patients and that male RA should be considered an occupational disease. To the best of our knowledge, this is the first review of occupations as a risk factor for RA in relation to the potential underlying pathophysiology.
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Affiliation(s)
- Dan Murphy
- Rheumatology Department, Royal Cornwall Hospital, Truro, Cornwall TR1 3LH, UK.,University of Exeter Medical School, Cornwall Campus, Knowledge Spa, Truro, Cornwall, TR1 3HD, UK.,St. Austell Healthcare Group, Wheal Northey Surgery, St Austell, Cornwall, PL25 3EF, UK
| | - David Hutchinson
- Rheumatology Department, Royal Cornwall Hospital, Truro, Cornwall TR1 3LH, UK.,University of Exeter Medical School, Cornwall Campus, Knowledge Spa, Truro, Cornwall, TR1 3HD, UK
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Abstract
PURPOSE OF REVIEW This review examines evidence relating environmental factors to the development of systemic lupus erythematosus (SLE). RECENT FINDINGS The strongest epidemiologic evidence exists for the associations of silica, cigarette smoking, oral contraceptives, postmenopausal hormone therapy and endometriosis, with SLE incidence. Recent studies have also provided robust evidence of the association between alcohol consumption and decreased SLE risk. There are preliminary, conflicting or unsubstantiated data that other factors, including air pollution, ultraviolet light, infections, vaccinations, solvents, pesticides and heavy metals such as mercury, are related to SLE risk. Biologic mechanisms linking environmental exposures and SLE risk include increased oxidative stress, systemic inflammation and inflammatory cytokine upregulation, and hormonal triggers, as well as epigenetic modifications resulting from exposure that could lead to SLE. SUMMARY Identifying the environmental risk factors related to risk of SLE is essential as it will lead to increased understanding of pathogenesis of this complex disease and will also make risk factor modification possible for those at increased risk.
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Parks CG, de Souza Espindola Santos A, Barbhaiya M, Costenbader KH. Understanding the role of environmental factors in the development of systemic lupus erythematosus. Best Pract Res Clin Rheumatol 2017; 31:306-320. [PMID: 29224673 PMCID: PMC5729939 DOI: 10.1016/j.berh.2017.09.005] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 08/16/2017] [Accepted: 09/03/2017] [Indexed: 12/20/2022]
Abstract
Systemic lupus erythematosus (SLE) is a multisystem disease with a complex etiology. Its risk is higher among women, racial and ethnic minorities, and individuals with a family history of SLE or related autoimmune diseases. It is believed that genetic factors interact with environmental exposures throughout the lifespan to influence susceptibility to developing SLE. The strongest epidemiologic evidence exists for increased risk of SLE associated with exposure to crystalline silica, current cigarette smoking, use of oral contraceptives, and postmenopausal hormone replacement therapy, while there is an inverse association with alcohol use. Emerging research results suggest possible associations of SLE risk with exposure to solvents, residential and agricultural pesticides, heavy metals, and air pollution. Ultraviolet light, certain infections, and vaccinations have also been hypothesized to be related to SLE risk. Mechanisms linking environmental exposures and SLE include epigenetic modifications resulting from exposures, increased oxidative stress, systemic inflammation and inflammatory cytokine upregulation, and hormonal effects. Research needs to include new studies of environmental risk factors for SLE in general, with a focus on lifetime exposure assessment. In addition, studies in susceptible subgroups, such as family members, studies based on genetic risk profiles, and studies in individuals with evidence of pre-clinical autoimmunity based on the detection of specific auto-antibodies are also required. Understanding the role of environmental exposures in the development of SLE may help identify modifiable risk factors and potential etiological mechanisms.
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Affiliation(s)
- Christine G Parks
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Durham, NC, USA
| | - Aline de Souza Espindola Santos
- Occupational and Environmental Health Branch, Public Health Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Medha Barbhaiya
- Department of Medicine, Division of Rheumatology, Hospital for Special Surgery, Weill-Cornell Medical School, New York, NY, USA
| | - Karen H Costenbader
- Department of Medicine, Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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45
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Environmental factors and hormones in the development of rheumatoid arthritis. Semin Immunopathol 2017; 39:461-468. [PMID: 28451785 DOI: 10.1007/s00281-017-0624-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 04/02/2017] [Indexed: 12/22/2022]
Abstract
The etiopathogenesis of rheumatoid arthritis (RA) is partially understood. Genetic, environmental, and hormonal factors and their interactions are considered to play an important role on disease development. The relative contribution of environmental factors to RA development is probably larger than previously thought. The aim of this review is to appraise robust evidence about the role of environmental and hormonal risk factors for RA. We will discuss inhaled pollutants, nutritional habits, infectious, hormonal, and reproductive factors. As some of these factors are potentially modifiable, understanding their impact on RA development opens new opportunities for potential interventions and disease prevention.
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46
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Lescoat A, Cavalin C, Macchi O, Jégo P, Rosental PA. Silica-associated systemic sclerosis in 2017: 60 years after Erasmus, where do we stand? Clin Rheumatol 2017; 36:1209-1210. [PMID: 28213786 DOI: 10.1007/s10067-017-3576-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 02/07/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Alain Lescoat
- UMR INSERM U1085, Research Institute in Health, Environment and Occupation / Institut de Recherche sur la Santé, l'Environnement et le Travail (IRSET), University of Rennes 1, Rennes, France. .,Department of Internal Medicine, CHU Rennes, University of Rennes 1, Rennes, France.
| | - Catherine Cavalin
- Silicosis project, ERC Advanced Grant, Centre for European Studies, Sciences Po, Paris, France.,Laboratory for Interdisciplinary Evaluation of Public Policies, Sciences Po, Paris, France.,Centre for Employment Studies, Noisy-le-Grand, France
| | - Odile Macchi
- Silicosis project, ERC Advanced Grant, Centre for European Studies, Sciences Po, Paris, France.,Centre for Historical Research, CNRS-EHESS, Paris, France
| | - Patrick Jégo
- UMR INSERM U1085, Research Institute in Health, Environment and Occupation / Institut de Recherche sur la Santé, l'Environnement et le Travail (IRSET), University of Rennes 1, Rennes, France.,Department of Internal Medicine, CHU Rennes, University of Rennes 1, Rennes, France
| | - Paul-André Rosental
- Silicosis project, ERC Advanced Grant, Centre for European Studies, Sciences Po, Paris, France.,National Institute for Demographic Studies (INED), Paris, France
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Anderson R, Meyer PWA, Ally MMTM, Tikly M. Smoking and Air Pollution as Pro-Inflammatory Triggers for the Development of Rheumatoid Arthritis. Nicotine Tob Res 2016; 18:1556-65. [PMID: 26957528 DOI: 10.1093/ntr/ntw030] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 01/27/2016] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Smoking is now well recognized not only as a risk factor for rheumatoid arthritis (RA), but also as a determinant of disease activity, severity, response to therapy, and possibly mortality. METHODS Studies, mostly recent, which have provided significant insights into the molecular and cellular mechanisms which underpin the pathogenesis of smoking-related RA, as well as the possible involvement of other types of outdoor and indoor pollution form the basis of this review. RESULTS Smoking initiates chronic inflammatory events in the lungs. These, in turn, promote the release of the enzymes, peptidylarginine deiminases 2 and 4 from smoke-activated, resident and infiltrating pulmonary phagocytes. Peptidylarginine deiminases mediate conversion of various endogenous proteins to putative citrullinated autoantigens. In genetically susceptible individuals, these autoantigens trigger the production of anti-citrullinated peptide, pathogenic autoantibodies, an event which precedes the development of RA. CONCLUSIONS An increasing body of evidence has linked chronic inflammatory events in the lungs of smokers, to the production of anti-citrullinated peptide autoantibodies and development of RA. Creation of awareness of the associated risks, assessment of smoking status and implementation of compelling antismoking strategies must be included in the routine clinical management of patients presenting with suspected RA. IMPLICATIONS Chronic inflammatory mechanisms operative in the lungs of smokers lead to the production of anti-citrullinated protein antibodies which, in turn, drive the development of RA. These mechanistic insights not only reinforce the association between smoking and risk for RA, but also the necessity to increase the level of awareness in those at highest risk.
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Affiliation(s)
- Ronald Anderson
- Institute for Cellular and Molecular Medicine, Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa;
| | - Pieter W A Meyer
- Department of Immunology, Faculty of Health Sciences, University of Pretoria and Tshwane Academic Division of the National Health Laboratory Service, Pretoria, South Africa
| | - Mahmood M T M Ally
- Department of Internal Medicine, Faculty of Health Sciences, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa
| | - Mohammed Tikly
- Division of Rheumatology, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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48
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Campos G, Eisenreich MA, Lopes LM, D'Avila R, do Prado AD, Bredemeier M. Antisynthetase syndrome after acute massive inhalation of wood and paint dust. Scand J Rheumatol 2016; 45:425-6. [PMID: 26948811 DOI: 10.3109/03009742.2015.1135981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Ggd Campos
- a Rheumatology Service , Hospital Nossa Senhora, the Conceição Hospital Group , Porto Alegre , Brazil
| | - M A Eisenreich
- a Rheumatology Service , Hospital Nossa Senhora, the Conceição Hospital Group , Porto Alegre , Brazil
| | - L M Lopes
- a Rheumatology Service , Hospital Nossa Senhora, the Conceição Hospital Group , Porto Alegre , Brazil
| | - R D'Avila
- a Rheumatology Service , Hospital Nossa Senhora, the Conceição Hospital Group , Porto Alegre , Brazil
| | - A D do Prado
- a Rheumatology Service , Hospital Nossa Senhora, the Conceição Hospital Group , Porto Alegre , Brazil
| | - M Bredemeier
- a Rheumatology Service , Hospital Nossa Senhora, the Conceição Hospital Group , Porto Alegre , Brazil
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49
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Urologische Malignome und rheumatoide Arthritis. Z Rheumatol 2016; 75:54-62. [DOI: 10.1007/s00393-015-0031-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Zusammenfassung
Urologische Malignome sind relativ häufig und nehmen mit zunehmendem Lebensalter zu. Der demografische Wandel führt dazu, dass bei immer mehr Patienten mit entzündlich-rheumatischen Erkrankungen urogenitale Tumoren koinzident sind oder unter antirheumatischer Therapie auftreten. Die Basistherapie rheumatischer Erkrankungen muss in dieses Fällen individuell sorgfältig abgewogen werden, obwohl die begrenzte Evidenz für die meisten Situationen gegen eine massive Risikoerhöhung durch konventionelle und/oder biologische Basistherapeutika spricht. Paraneoplastische Phänomene auch im Bewegungsapparat können durch urogenitale Malignome ausgelöst werden. Mit den sich abzeichnenden Umwälzungen der medikamentösen Tumortherapie durch die Immunonkologie ergeben sich darüber hinaus neue Herausforderungen für die interdisziplinäre Kooperation von Uroonkologen und Rheumatologen. In dieser Übersichtsarbeit werden unter Berücksichtigung der aktuellen deutschen und europäischen Leitlinien die Diagnostik, Standardbehandlung und Nachsorge urologischer Malignome skizziert. Wir beschreiben Kernaspekte, die von Urologen und Rheumatologen beachtet werden sollten. Durch persönliche Absprache, regelmäßigen Erfahrungsaustausch und Einbeziehung von Rheumatologen in interdisziplinäre Tumorboards sollte zukünftig eine bessere Behandlung unserer gemeinsamen Patienten möglich werden.
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50
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Wood Dust: A Trigger for Rheumatoid Arthritis? Am J Med 2015; 128:e35. [PMID: 26592315 DOI: 10.1016/j.amjmed.2015.06.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 06/25/2015] [Accepted: 06/25/2015] [Indexed: 11/20/2022]
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