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Yanosky JD, Washington A, Foulke GT, Guck D, Butt M, Helm MF. Air pollution and incident sarcoidosis in central Pennsylvania. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2024; 87:763-772. [PMID: 38922578 DOI: 10.1080/15287394.2024.2369255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
Sarcoidosis is a chronic granulomatous disease predominantly affecting the lungs and inducing significant morbidity and elevated mortality rate. The etiology of the disease is unknown but may involve exposure to an antigenic agent and subsequent inflammatory response resulting in granuloma formation. Various environmental and occupational risk factors have been suggested by previous observations, such as moldy environments, insecticides, and bird breeding. Our study investigated the association of air pollution with diagnosis of sarcoidosis using a case-control design. Penn State Health electronic medical records from 2005 to 2018 were examined for adult patients with (cases) and without (controls) an International Classification of Disease (ICD)-9 or -10 code for sarcoidosis. Patient addresses were geocoded and 24-hr residential-level air pollution concentrations were estimated using spatio-temporal models of particulate matter <2.5 μm (PM2.5), ozone, and PM2.5 elemental carbon (EC) and moving averages calculated. In total, 877 cases and 34,510 controls were identified. Logistic regression analysis did not identify significant associations between sarcoidosis incidence and air pollution exposure estimates. However, the odds ratio (OR) for EC for exposures occurring 7-10 years prior did approach statistical significance, and ORs exhibited an increasing trend for longer averaging periods. Data suggested a latency period of more than 6 years for PM2.5 and EC for reasons that are unclear. Overall, results for PM2.5 and EC suggest that long-term exposure to traffic-related air pollution may contribute to the development of sarcoidosis and emphasize the need for additional research and, if the present findings are substantiated, for public health interventions addressing air quality as well as increasing disease surveillance in areas with a large burden of PM2.5 and EC.
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Affiliation(s)
- Jeff D Yanosky
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Abigail Washington
- Department of Medicine, Penn State College of Medicine, Hershey, PA, USA
| | - Galen T Foulke
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
- Department of Dermatology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Daniel Guck
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Melissa Butt
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
- Department of Family and Community Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Matthew F Helm
- Department of Dermatology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
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Harper LJ, Farver CF, Yadav R, Culver DA. A framework for exclusion of alternative diagnoses in sarcoidosis. J Autoimmun 2024:103288. [PMID: 39084998 DOI: 10.1016/j.jaut.2024.103288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 07/02/2024] [Accepted: 07/13/2024] [Indexed: 08/02/2024]
Abstract
Sarcoidosis is a multisystem granulomatous syndrome that arises from a persistent immune response to a triggering antigen(s). There is no "gold standard" test or algorithm for the diagnosis of sarcoidosis, making the diagnosis one of exclusion. The presentation of the disease varies substantially between individuals, in both the number of organs involved, and the manifestations seen in individual organs. These qualities dictate that health care providers diagnosing sarcoidosis must consider a wide range of possible alternative diagnoses, from across a range of presentations and medical specialties (infectious, inflammatory, cardiac, neurologic). Current guideline-based diagnosis of sarcoidosis recommends fulfillment of three criteria: 1) compatible clinical presentation and/or imaging 2) demonstration of granulomatous inflammation by biopsy (when possible) and, 3) exclusion of alternative causes, but do not provide guidance on standardized strategies for exclusion of alternative diagnoses. In this review, we provide a summary of the most common differential diagnoses for sarcoidosis involvement of lung, eye, skin, central nervous system, heart, liver, and kidney. We then propose a framework for testing to exclude alternative diagnoses based on pretest probability of sarcoidosis, defined as high (typical findings with sarcoidosis involvement confirmed in another organ), moderate (typical findings in a single organ), or low (atypical/findings suggesting of an alternative diagnosis). This work highlights the need for informed and careful exclusion of alternative diagnoses in sarcoidosis.
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Affiliation(s)
- Logan J Harper
- Department of Pulmonary and Critical Care Medicine, Integrated Hospital Care Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Carol F Farver
- Department of Pathology, Cleveland Clinic, Cleveland, OH, USA
| | - Ruchi Yadav
- Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Daniel A Culver
- Department of Pulmonary and Critical Care Medicine, Integrated Hospital Care Institute, Cleveland Clinic, Cleveland, OH, USA
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Iversen IB, Vestergaard JM, Ohlander J, Peters S, Bendstrup E, Bonde JPE, Schlünssen V, Bønløkke JH, Rasmussen F, Stokholm ZA, Andersen MB, Kromhout H, Kolstad HA. Occupational exposure to respirable crystalline silica and incident idiopathic interstitial pneumonias and pulmonary sarcoidosis: a national prospective follow-up study. Occup Environ Med 2024; 81:279-286. [PMID: 38902031 PMCID: PMC11287551 DOI: 10.1136/oemed-2023-108964] [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: 04/21/2023] [Accepted: 04/26/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Respirable crystalline silica is a well-known cause of silicosis but may also be associated with other types of interstitial lung disease. We examined the associations between occupational exposure to respirable crystalline silica and the risk of idiopathic interstitial pneumonias, pulmonary sarcoidosis and silicosis. METHODS The total Danish working population was followed 1977-2015. Annual individual exposure to respirable crystalline silica was estimated using a quantitative job exposure matrix. Cases were identified in the Danish National Patient Register. We conducted adjusted analyses of exposure-response relations between cumulative silica exposure and other exposure metrics and idiopathic interstitial pneumonias, pulmonary sarcoidosis and silicosis. RESULTS Mean cumulative exposure was 125 µg/m3-years among exposed workers. We observed increasing incidence rate ratios with increasing cumulative silica exposure for idiopathic interstitial pneumonias, pulmonary sarcoidosis and silicosis. For idiopathic interstitial pneumonias and pulmonary sarcoidosis, trends per 50 µg/m3-years were 1.03 (95% CI 1.02 to 1.03) and 1.06 (95% CI 1.04 to 1.07), respectively. For silicosis, we observed the well-known exposure-response relation with a trend per 50 µg/m3-years of 1.20 (95% CI 1.17 to 1.23). CONCLUSION This study suggests that silica inhalation may be related to pulmonary sarcoidosis and idiopathic interstitial pneumonias, though these findings may to some extent be explained by diagnostic misclassification. The observed exposure-response relations for silicosis at lower cumulative exposure levels than previously reported need to be corroborated in analyses that address the limitations of this study.
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Affiliation(s)
- Inge Brosbøl Iversen
- 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
| | - Johan Ohlander
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Susan Peters
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Elisabeth Bendstrup
- Center for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Peter Ellekilde Bonde
- Department of Occupational and Environmental Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Vivi Schlünssen
- Department of Public Health, Research Unit for Environment, Occupation and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark
| | - Jakob Hjort Bønløkke
- Department of Occupational and Environmental Medicine, Danish Ramazzini Centre, Aalborg University Hospital, Aalborg, Denmark
| | - Finn Rasmussen
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Zara Ann Stokholm
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Brun Andersen
- Department of Radiology, Copenhagen University Hospital Herlev and Gentofte, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Hans Kromhout
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Henrik Albert Kolstad
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Rezai M, Nayebzadeh A, Catli S, McBride D. Occupational exposures and sarcoidosis: a rapid review of the evidence. Occup Med (Lond) 2024; 74:266-273. [PMID: 38776441 PMCID: PMC11165367 DOI: 10.1093/occmed/kqae016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Sarcoidosis is a rare, multisystem, inflammatory condition associated with the formation of granulomas. Diagnosis can be challenging because of non-specific symptoms complicating epidemiological investigations of its aetiology. Despite research efforts, a review of the current state of the evidence is needed. AIMS To assess the evidence for an association between occupational exposures and the development of sarcoidosis. To determine if workers in any occupation are at a greater risk of developing sarcoidosis. METHODS This rapid review follows the methodology suggested by the World Health Organization. Two electronic databases were systematically searched until April 2022. The methodological quality of the studies was critically appraised, and a best-evidence approach was used to synthesize the results. RESULTS Titles and abstracts of 2916 articles were screened, with 67 full-text articles reviewed for eligibility. Among the 13 studies eligible for this review, none were of high quality (i.e. low risk of bias). Six studies exploring the association between sarcoidosis and a range of occupations and exposures, and one previous systematic review were of low quality reporting inconsistent findings. Six studies examined the risk of sarcoidosis associated with occupational silica exposure, two of which were of acceptable quality. Overall, the study methodologies and results were inadequate to support causal relationships. CONCLUSIONS There is limited evidence of acceptable methodological quality to assess the risk of sarcoidosis associated with occupational exposures. There is a growing body of research examining occupational exposure to silica and sarcoidosis. Additional high-quality confirmatory research is needed.
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Affiliation(s)
- M Rezai
- Policy and Consultation Services Division, Workplace Safety and Insurance Board (Ontario), Toronto, Ontario M5V 3J1, Canada
| | - A Nayebzadeh
- Policy and Consultation Services Division, Workplace Safety and Insurance Board (Ontario), Toronto, Ontario M5V 3J1, Canada
| | - S Catli
- Policy and Consultation Services Division, Workplace Safety and Insurance Board (Ontario), Toronto, Ontario M5V 3J1, Canada
| | - D McBride
- Policy and Consultation Services Division, Workplace Safety and Insurance Board (Ontario), Toronto, Ontario M5V 3J1, Canada
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Kosarek NN, Preston EV. Contributions of Synthetic Chemicals to Autoimmune Disease Development and Occurrence. Curr Environ Health Rep 2024; 11:128-144. [PMID: 38653907 DOI: 10.1007/s40572-024-00444-9] [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: 03/22/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE OF REVIEW Exposure to many synthetic chemicals has been linked to a variety of adverse human health effects, including autoimmune diseases. In this scoping review, we summarize recent evidence detailing the effects of synthetic environmental chemicals on autoimmune diseases and highlight current research gaps and recommendations for future studies. RECENT FINDINGS We identified 68 recent publications related to environmental chemical exposures and autoimmune diseases. Most studies evaluated exposure to persistent environmental chemicals and autoimmune conditions including rheumatoid arthritis (RA), systemic lupus (SLE), systemic sclerosis (SSc), and ulcerative colitis (UC) and Crohn's disease. Results of recent original research studies were mixed, and available data for some exposure-outcome associations were particularly limited. PFAS and autoimmune inflammatory bowel diseases (UC and CD) and pesticides and RA appeared to be the most frequently studied exposure-outcome associations among recent publications, despite a historical research focus on solvents. Recent studies have provided additional evidence for the associations of exposure to synthetic chemicals with certain autoimmune conditions. However, impacts on other autoimmune outcomes, particularly less prevalent conditions, remain unclear. Owing to the ubiquitous nature of many of these exposures and their potential impacts on autoimmune risk, additional studies are needed to better evaluate these relationships, particularly for understudied autoimmune conditions. Future research should include larger longitudinal studies and studies among more diverse populations to elucidate the temporal relationships between exposure-outcome pairs and to identify potential population subgroups that may be more adversely impacted by immune modulation caused by exposure to these chemicals.
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Affiliation(s)
- Noelle N Kosarek
- Department of Biomedical Data Science, Dartmouth College, Hanover, NH, 03755, USA
| | - Emma V Preston
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Building 1, Floor 14, Boston, MA, 02115, USA.
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Robert M, Yatim N, Sacré K, Duffy D. Sarcoidosis immunopathogenesis - a new concept of maladaptive trained immunity. Trends Immunol 2024; 45:406-418. [PMID: 38796404 DOI: 10.1016/j.it.2024.04.013] [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: 03/26/2024] [Revised: 04/30/2024] [Accepted: 04/30/2024] [Indexed: 05/28/2024]
Abstract
Sarcoidosis is a chronic immune disease of unknown origin for which we still lack an immunological framework unifying causal agents, host factors, and natural history of disease. Here, we discuss the initial triggers of disease, and how myeloid cells drive granuloma formation and contribute to immunopathogenesis. We highlight recent advances in our understanding of innate immune memory and propose the hypothesis that maladaptive innate immune training connects previous environmental exposure to granuloma maintenance and expansion. Lastly, we consider how this hypothesis may open novel therapeutic avenues, while corticosteroids remain the front-line treatment.
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Affiliation(s)
- Marie Robert
- Translational Immunology Unit, Institut Pasteur, Université Paris-Cité, Paris, France; Department of Internal Medicine, Hôpital Bichat, Paris, France; Université Paris-Cité, Centre de Recherche sur l'Inflammation, INSERM UMR1149, CNRS ERL8252, Faculté de Médecine site Bichat, Laboratoire d'Excellence Inflamex, Paris, France
| | - Nader Yatim
- Translational Immunology Unit, Institut Pasteur, Université Paris-Cité, Paris, France; Department of Internal Medicine, Hôpital Bichat, Paris, France
| | - Karim Sacré
- Department of Internal Medicine, Hôpital Bichat, Paris, France; Université Paris-Cité, Centre de Recherche sur l'Inflammation, INSERM UMR1149, CNRS ERL8252, Faculté de Médecine site Bichat, Laboratoire d'Excellence Inflamex, Paris, France
| | - Darragh Duffy
- Translational Immunology Unit, Institut Pasteur, Université Paris-Cité, Paris, France; CBUtechS, Institut Pasteur, Université Paris-Cité, Paris, France.
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7
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Makdoumi K, Ayoub L, Bryngelsson IL, Graff P, Wiebert P, Vihlborg P. The risk for ophthalmological conditions in ulcerative colitis: A population-based case-control study. Is silica dust-exposure associated with inflammatory eye disease? Acta Ophthalmol 2024. [PMID: 38738471 DOI: 10.1111/aos.16708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/30/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE To study the risk for eye diseases in individuals with Ulcerative Colitis (UC), and to assess whether silica dust-exposure could contribute to the development of inflammatory eye diseases. METHODS A case-control study was conducted using a patient register processed by the National Board of Health and Welfare (NBHW) and Statistics Sweden. Cases were diagnosed with UC between 2007 and 2016. Matching was done with two random controls having the same age, sex and county of residence, without a systemic inflammatory disease. Using a job-exposure matrix, cases and controls were assessed for work-related silica dust exposure. The risk for eye disease was estimated by Cox regression analysis with calculation of Hazard Ratio (HR). RESULTS A total of 58 989 individuals were included, comprising 19 663 cases and 39 326 controls. The sex distribution was similar. Overall, individuals with UC had an increased risk for eye disease, specified in ICD 10 chapter VII (H00-H59) with HR 1.25 (CI 1.20-1.32). The highest HR on block-level for cases was 1.52 (CI 1.36-1.70), (H15-H22), which includes episcleritis, keratitis and anterior uveitis. The risk for ocular disease was higher in silica dust-exposed than non-exposed with a HR of 1.44 (CI 1.16-1.78) and 1.25 (CI 1.19-1.31), respectively. Among cases, the risk for iridocyclitis (H20) was further elevated by silica dust exposure, with HR of 3.84 (CI 1.64-8.97) in exposed compared to 1.94 (1.57-2.41) in non-exposed. CONCLUSION UC is associated with an increased risk for eye diseases, including inflammatory conditions. Our findings highlight that silica dust-exposure may be of importance in the pathogenesis of uveitis.
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Affiliation(s)
- Karim Makdoumi
- Department of Ophthalmology, Faculty of Medicine and Health, Orebro University, Orebro, Sweden
| | - Lucyn Ayoub
- School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Ing-Liss Bryngelsson
- Department of Ophthalmology, Faculty of Medicine and Health, Orebro University, Orebro, Sweden
- Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, Orebro University, Orebro, Sweden
| | - Pål Graff
- National Institute of Occupational Health (STAMI), Oslo, Norway
| | - Pernilla Wiebert
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Center for Occupational and Environmental Medicine, Stockholm, Sweden
| | - Per Vihlborg
- Department of Geriatrics, Faculty of Medicine and Health, Orebro University, Orebro, Sweden
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Davaajav K, Dagva D, Dashtseren I, Takahashi Y, Nakayama T. Elevated Levels of the Cancer Marker Neuron-Specific Enolase in a Patient With Coexisting Silicosis and Sarcoidosis. Cureus 2024; 16:e61130. [PMID: 38919222 PMCID: PMC11198998 DOI: 10.7759/cureus.61130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2024] [Indexed: 06/27/2024] Open
Abstract
In a periodical medical checkup, a 39-year-old Mongolian underground miner was diagnosed with silicosis based on chest radiography, computed tomography (CT), and work history. Chest radiography showed diffuse bilateral rounded nodules in both lung fields, with upper lobe dominance and large opacities in the right upper zone. Chest CT presented conglomerated massive changes in the right upper lobe and the coalescence of small nodules in the left upper lung. In the blood test, serum levels of the lung cancer marker neuron-specific enolase (NSE) were elevated (24.58 ng/mL). Carcinoembryonic antigen (CEA) and cytokeratin 19 fragment (CYFRA 21-1) levels were within the reference range. Subsequent to the suspicion of a tumour in the right upper lobe, a right upper lobectomy was performed. The histopathological examination of the lung specimen revealed the coalescence of numerous silica nodules, accompanied by indications of associated sarcoidosis. The histological features suggested the presence of two concurrent pathological processes: silicosis and sarcoidosis. This case demonstrated the combination of three clinical conditions diagnosed in one patient, including complicated silicosis associated with sarcoidosis and elevated serum NSE levels. This case report may serve as a foundation for future investigations exploring the potential of NSE as a marker for silicosis.
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Affiliation(s)
| | - Dolgormaa Dagva
- Forensic Medicine, National Forensic Agency of Mongolia, Ulaanbaatar, MNG
| | - Ichinnorov Dashtseren
- Pulmonology and Allergology, Mongolian National University of Medical Sciences, School of Medicine, Ulaanbaatar, MNG
| | | | - Takeo Nakayama
- Health Informatics, Kyoto University, Graduate School of Medicine, Kyoto, JPN
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Venetsanopoulou AI, Alamanos Y, Voulgari PV, Drosos AA. Epidemiology and Risk Factors for Rheumatoid Arthritis Development. Mediterr J Rheumatol 2023; 34:404-413. [PMID: 38282942 PMCID: PMC10815538 DOI: 10.31138/mjr.301223.eaf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 10/24/2023] [Accepted: 10/31/2023] [Indexed: 01/30/2024] Open
Abstract
Rheumatoid arthritis (RA) is a prevalent chronic inflammatory arthritis worldwide, significantly impacting patients and population health. The disease affects women primarily, with a female-to-male ratio of three to one. Its pathogenesis is multifactorial, including genetic and environmental risk factors. Epidemiological studies highlight the link between the environment and genetic susceptibility to RA. The so-called shared epitope is the most significant risk factor that seems to act synergetic with other environmental factors in the disease occurrence. In addition, recent findings suggest a potential role of new substantial environmental factors, such as the observed pollution of the planet's natural resources, on the susceptibility and progression of the disease. This review summarises the most decisive evidence on epidemiology and genetic, environmental, and lifestyle risk factors for RA. It shows that studying genetic and environmental factors in correlation could lead to prevention strategies that may impact the natural history of the disease.
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Affiliation(s)
- Aliki I. Venetsanopoulou
- Department of Rheumatology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Yannis Alamanos
- Institute of Epidemiology, Preventive Medicine and Public Health, Corfu, Greece
| | - Paraskevi V. Voulgari
- Department of Rheumatology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Alexandros A. Drosos
- Department of Rheumatology, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
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Huntley CC, Patel K, Mughal AZ, Coelho S, Burge PS, Turner AM, Walters GI. Airborne occupational exposures associated with pulmonary sarcoidosis: a systematic review and meta-analysis. Occup Environ Med 2023; 80:580-589. [PMID: 37640537 DOI: 10.1136/oemed-2022-108632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 07/05/2023] [Indexed: 08/31/2023]
Abstract
The aetiology and pathophysiology of sarcoidosis is ill defined-current hypotheses centre on complex genetic-immune-environmental interactions in an individual, triggering a granulomatous process. The aim of this systematic review is to define and describe which airborne occupational exposures (aOE) are associated with and precede a diagnosis of pulmonary sarcoidosis. The methodology adopted for the purpose was systematic review and meta-analyses of ORs for specified aOE associated with pulmonary sarcoidosis (DerSimonian Laird random effects model (pooled log estimate of OR)). Standard search terms and dual review at each stage occurred. A compendium of aOE associated with pulmonary sarcoidosis was assembled, including mineralogical studies of sarcoidosis granulomas. N=81 aOE were associated with pulmonary sarcoidosis across all study designs. Occupational silica, pesticide and mould or mildew exposures were associated with increased odds of pulmonary sarcoidosis. Occupational nickel and aluminium exposure were associated with a non-statistically significant increase in the odds of pulmonary sarcoidosis. Silica exposure associated with pulmonary sarcoidosis was reported most frequently in the compendium (n=33 studies) and was the most common mineral identified in granulomas. It was concluded that aOE to silica, pesticides and mould or mildew are associated with increased odds of pulmonary sarcoidosis. Equipoise remains concerning the association and relationship of metal dusts with pulmonary sarcoidosis.
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Affiliation(s)
- Christopher C Huntley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Occupational and Interstitial Lung Disease Services, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ketan Patel
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | | | - P Sherwood Burge
- Occupational and Interstitial Lung Disease Services, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Alice M Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Gareth I Walters
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Occupational and Interstitial Lung Disease Services, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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11
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Umeano L, Pujari HP, Nasiri SMZJ, Parisapogu A, Shah A, Montaser J, Mohammed L. The Association Between Lung Cancer and Sarcoidosis: A Literature Review. Cureus 2023; 15:e45508. [PMID: 37868478 PMCID: PMC10585050 DOI: 10.7759/cureus.45508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
Lung cancer is responsible for a significant number of cancer-related deaths worldwide. While various factors can lead to lung cancer, such as tobacco smoking, this article focuses on the relationship between sarcoidosis, a multisystem granulomatous disorder, and lung neoplasm. To investigate this association, the authors conducted a literature search using relevant keywords. The analysis of these reports concluded that while Sarcoidosis and lung cancer together is rare, it is possible. The presenting symptoms, age, gender, and diagnostic procedures of each case should be evaluated, and appropriate diagnostic procedures should be carried out to determine the appropriate treatment for each patient. Clinicians need to be aware of the possibility of these two diseases co-occurring, as they can impact the management of the patient's condition, whether it is curative or palliative. It is essential to rule out metastatic cancer in individuals with sarcoidosis-like clinical and radiographic features.
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Affiliation(s)
- Lotanna Umeano
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Hari Priya Pujari
- Diagnostic Radiology, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | | | - Anusha Parisapogu
- Infectious Disease, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
- Infectious Disease, Mayo Clinic, Rochester, USA
| | - Anuj Shah
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Jamal Montaser
- Psychiatry, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Lubna Mohammed
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
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Widajati N, Martiana T, Utami TN, Jalaludin J, Hamedon TR. Lung Function Analysis of Marble Home Industry Workers in Tulungagung Regency. PERTANIKA JOURNAL OF SCIENCE AND TECHNOLOGY 2023. [DOI: 10.47836/pjst.31.2.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
This study analyzes the effect of dust exposure and worker characteristics on lung function. This type of research was observational with a cross-sectional design. The population was 20 marble home industry workers in Tulungagung. The total population technique determined the sample. Data analysis was carried out using Smart PLS software. The study results found that sociodemography, including age, nutritional status, and years of service, affected lung function with a t-statistic of 2.604. Dust exposure, which includes respirable dust content and duration of exposure, impacted lung function with a t-statistic of 2.522. Marble artisans in Tulungagung with the age of >35 years and a long working period of >5 years with a level of exposure to silica dust >3 mg/m3 and supported by a long working period of >7 hours had great potential for lung function. The recommendation was for home industry entrepreneurs to provide masks according to standards. The role of public health center officers was to monitor the work environment and regularly check home industry workers’ health.
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Vanka KS, Shukla S, Gomez HM, James C, Palanisami T, Williams K, Chambers DC, Britton WJ, Ilic D, Hansbro PM, Horvat JC. Understanding the pathogenesis of occupational coal and silica dust-associated lung disease. Eur Respir Rev 2022; 31:31/165/210250. [PMID: 35831008 DOI: 10.1183/16000617.0250-2021] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 04/20/2022] [Indexed: 01/15/2023] Open
Abstract
Workers in the mining and construction industries are at increased risk of respiratory and other diseases as a result of being exposed to harmful levels of airborne particulate matter (PM) for extended periods of time. While clear links have been established between PM exposure and the development of occupational lung disease, the mechanisms are still poorly understood. A greater understanding of how exposures to different levels and types of PM encountered in mining and construction workplaces affect pathophysiological processes in the airways and lungs and result in different forms of occupational lung disease is urgently required. Such information is needed to inform safe exposure limits and monitoring guidelines for different types of PM and development of biomarkers for earlier disease diagnosis. Suspended particles with a 50% cut-off aerodynamic diameter of 10 µm and 2.5 µm are considered biologically active owing to their ability to bypass the upper respiratory tract's defences and penetrate deep into the lung parenchyma, where they induce potentially irreversible damage, impair lung function and reduce the quality of life. Here we review the current understanding of occupational respiratory diseases, including coal worker pneumoconiosis and silicosis, and how PM exposure may affect pathophysiological responses in the airways and lungs. We also highlight the use of experimental models for better understanding these mechanisms of pathogenesis. We outline the urgency for revised dust control strategies, and the need for evidence-based identification of safe level exposures using clinical and experimental studies to better protect workers' health.
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Affiliation(s)
- Kanth Swaroop Vanka
- School of Biomedical Sciences and Pharmacy, The University of Newcastle/Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, The University of Newcastle, Newcastle, NSW, Australia.,Division of Pulmonary, Allergy, and Critical Care Medicine, Dept of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Lung Biology Institute, University of Pennsylvania, Philadelphia, PA, USA
| | - Shakti Shukla
- Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Henry M Gomez
- School of Biomedical Sciences and Pharmacy, The University of Newcastle/Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, The University of Newcastle, Newcastle, NSW, Australia
| | - Carole James
- School of Health Sciences, The University of Newcastle, Newcastle, NSW, Australia
| | - Thava Palanisami
- Global Innovative Centre for Advanced Nanomaterials, College of Engineering, Science and Environment (CERSE), The University of Newcastle, Newcastle, NSW, Australia
| | - Kenneth Williams
- Newcastle Institute for Energy and Resources (NIER), School of Engineering, The University of Newcastle, Newcastle, NSW, Australia
| | - Daniel C Chambers
- School of Clinical Medicine, The University of Queensland, Brisbane, QLD, Australia.,Queensland Lung Transplant Program, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Warwick J Britton
- Centenary Institute, The University of Sydney, Sydney, NSW, Australia.,Dept of Clinical Immunology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Dusan Ilic
- Newcastle Institute for Energy and Resources (NIER), School of Engineering, The University of Newcastle, Newcastle, NSW, Australia
| | - Philip Michael Hansbro
- School of Biomedical Sciences and Pharmacy, The University of Newcastle/Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, The University of Newcastle, Newcastle, NSW, Australia.,Centre for Inflammation, Centenary Institute, Sydney, NSW, Australia.,School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW, Australia.,P.M. Hansbro and J.C. Horvat have equally contributed as senior authors
| | - Jay Christopher Horvat
- School of Biomedical Sciences and Pharmacy, The University of Newcastle/Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, The University of Newcastle, Newcastle, NSW, Australia .,P.M. Hansbro and J.C. Horvat have equally contributed as senior authors
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14
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Gustavsson P, Wiebert P, Tinnerberg H, Bodin T, Linnersjö A, Myrberg IH, Albin M, Selander J. Time trends in occupational exposure to chemicals in Sweden: proportion exposed, distribution across demographic and labor market strata, and exposure levels. Scand J Work Environ Health 2022; 48:479-489. [PMID: 35696552 PMCID: PMC9888437 DOI: 10.5271/sjweh.4040] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE This study investigated time trends in occupational exposure to various chemicals in Sweden and the distribution across demographic and labor market sectors. METHODS Exposure to six chemicals was investigated from 1980 to 2013 by application of a job exposure matrix to national population registers. Respirable crystalline silica (RCS), diesel engine exhaust, welding fumes, wood dust, chlorinated hydrocarbon solvents, and lead were selected to represent different groups of chemicals. Trends in exposure prevalence were investigated by linear regression and compared to the occupationally active population. Confidence intervals for the rate of change over time were obtained by bootstrapping. RESULTS The proportion of workers born outside the Nordic countries increased over time in those exposed to RCS, diesel exhaust and wood dust. There was a shift of exposed jobs to small companies (<50 employees), especially for RCS, welding fumes, wood dust, and chlorinated hydrocarbon solvents. For RCS and welding fumes, there was a marked drop in exposure levels from 1980 to 1990 but small changes thereafter. Exposure to lead diminished, both in terms of prevalence and intensity. CONCLUSIONS Over time, several exposures tended to shift to small companies, the construction sector, and migrant workers, all factors being indicative of less well-controlled working conditions. Occupational exposure to chlorinated organic solvents and lead diminished, while exposure levels to RCS and welding fumes have changed little since 1990. In view of the serious and well-established negative health effects, increased efforts to reduce exposure to RCS and welding fumes are needed.
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Affiliation(s)
- Per Gustavsson
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden,Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden,
Correspondence to: Per Gustavsson, Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Solnavägen 4, 113 65 Stockholm, Sweden. [E-mail: ]
| | - Pernilla Wiebert
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden,Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Håkan Tinnerberg
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden,School of Public Health and Community Medicine, Gothenburg University, Gothenburg, Sweden
| | - Theo Bodin
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden,Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Anette Linnersjö
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden,Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Ida Hed Myrberg
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Maria Albin
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden,Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Jenny Selander
- Unit of Occupational Medicine, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden,Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
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15
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Ryan SM, Mroz MM, Herzog EL, Ryu C, Fingerlin TE, Maier LA, Gulati M. Occupational and environmental exposures in the Genomic Research in Alpha-1 Antitrypsin Deficiency and Sarcoidosis (GRADS) study. Respir Med 2022; 200:106923. [PMID: 35932543 DOI: 10.1016/j.rmed.2022.106923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/25/2022] [Accepted: 06/19/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Sarcoidosis is a granulomatous disorder thought to be caused by exposures in genetically susceptible individuals. This study investigated whether specific exposures were associated with different sarcoidosis phenotypes. METHODS Extensive demographic, occupational and environmental exposure data was analyzed from subjects enrolled in the NHLBI Genomic Research in Alpha-1 Antitrypsin Deficiency and Sarcoidosis (GRADS) study. RESULTS In patients with sarcoidosis, radiation exposure was significantly associated with an increased risk of cardiac sarcoidosis versus non-cardiac sarcoidosis. No exposures were significantly associated with pulmonary only disease versus extrapulmonary disease with or without pulmonary involvement, Scadding Stage II/III/IV versus Scadding Stage 0/I, acute or remitting disease versus non-acute or non-remitting disease, nor chronic versus non-chronic disease. Although not reaching statistically significance after adjustment for multiple comparisons, there were a number of exposures associated with specific disease phenotypes, including exposures where relationships to sarcoidosis have previously been described such as rural exposures and pesticide exposures. CONCLUSIONS Radiation exposure may be a risk factor for cardiac sarcoidosis. Other exposures may also be associated with specific phenotypes and should be further explored. The study was limited by small groups of exposed subjects for individual exposures and multiple comparisons. The development of novel and innovative exposure assessment tools is needed.
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Affiliation(s)
- Sarah M Ryan
- Colorado School of Public Health, Department of Biostatistics and Informatics, USA
| | - Margaret M Mroz
- National Jewish Health, Department of Medicine (Division of Environmental and Occupational Health Sciences), USA
| | - Erica L Herzog
- Yale University School of Medicine, Department of Medicine (Pulmonary, Critical Care and Sleep), USA
| | - Changwan Ryu
- Yale University School of Medicine, Department of Medicine (Pulmonary, Critical Care and Sleep), USA
| | - Tasha E Fingerlin
- National Jewish Health, Department of Immunology and Genomic Medicine, USA
| | - Lisa A Maier
- National Jewish Health, Department of Medicine (Division of Environmental and Occupational Health Sciences), USA; University of Colorado, Department of Medicine, USA
| | - Mridu Gulati
- Yale University School of Medicine, Department of Medicine (Pulmonary, Critical Care and Sleep), USA.
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16
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The Relationship between Tumor Development and Sarcoidosis in Aspects of Carcinogenesis before and after the Onset of Sarcoidosis. Medicina (B Aires) 2022; 58:medicina58060768. [PMID: 35744031 PMCID: PMC9230813 DOI: 10.3390/medicina58060768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/01/2022] [Accepted: 06/03/2022] [Indexed: 12/13/2022] Open
Abstract
Background and Objectives: It is still unclear whether sarcoidosis is likely to be associated with tumors. In addition, the use of an immune checkpoint inhibitor has been reported to initiate the onset of sarcoidosis. We retrospectively analyzed tumor development before and after the diagnosis of sarcoidosis and examined the impact of having a history of tumors on the activity or the severity of sarcoidosis. Materials and Methods: We recruited 312 consecutive cases of sarcoidosis and analyzed the tumor development before and after the onset of sarcoidosis. Results: Among them, 25 cases were diagnosed with malignant tumor after diagnosis of sarcoidosis. In the analysis of the tumor-development group after diagnosis of sarcoidosis, both serum angiotensin I-converting enzyme and mediastinal lymph node size were significantly reduced at the time of malignant tumor diagnosis compared to at the onset of sarcoidosis, indicating that the decreasing activity of sarcoidosis may be partly associated with tumor development. Furthermore, we examined 34 cases having tumor history before the onset of sarcoidosis and analyzed the effect of tumor history on the severity of sarcoidosis. Cases with a malignant tumor in the past were older and had less complicated organs of sarcoidosis than cases without malignant tumors in the past. Oral corticosteroid therapy was administrated more frequently in cases without malignant tumors in the past, indicating that the history of a malignant tumor may influence the severity of sarcoidosis. Conclusion: These results indicate that tumor development may be partly associated with the activity or severity of sarcoidosis.
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17
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Oliver LC, Sampara P, Pearson D, Martell J, Zarnke AM. Sarcoidosis in Northern Ontario hard-rock miners: A case series. Am J Ind Med 2022; 65:268-280. [PMID: 35156713 PMCID: PMC10138725 DOI: 10.1002/ajim.23333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 01/07/2022] [Accepted: 01/27/2022] [Indexed: 12/19/2022]
Abstract
Sarcoidosis is a rare multisystem granulomatous disease traditionally considered to be of unknown etiology. The notion that sarcoidosis has no known cause is called into question with the increasing number of case reports and epidemiologic studies showing associations between occupational exposures and disease published in the past 10-20 years. Occupational exposures for which associations are strongest and most consistent are silica and other inorganic dusts, World Trade Center (WTC) dust, and metals. Occupations identified as at-risk for sarcoidosis include construction workers; iron-foundry and diatomaceous earth workers; WTC emergency responders; and metal workers. We report here 12 cases of sarcoidosis in a cohort of hard-rock miners in Northern Ontario, Canada. To our knowledge sarcoidosis has not been reported previously in hard-rock miners. The cases are all male and Caucasian, with average age 74 years. At the time of diagnosis, two were never smokers; six, former smokers; and four, current smokers. Five have extrapulmonary sarcoidosis: two cardiac and three endocrine (hypercalciuria). Using occupational histories and air sampling data from the gold, uranium, and base-metal mines in which they worked, we examined exposure of each case to respirable crystalline silica (RCS). The annual mean RCS exposure for the 12 cases was 0.14 mg/m3 (range: 0.06-1.3 mg/m3 ); and the mean cumulative RCS exposure was 1.93 mg/m3 years (range: 0.64-4.03 mg/m3 years). We also considered their exposure to McIntyre Powder, an aluminum powder used for silicosis prophylaxis.
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Affiliation(s)
- L. Christine Oliver
- Dalla Lana School of Public Health, Division of Occupational and Environmental Health University of Toronto Toronto Ontario Canada
- The Occupational Health Clinics for Ontario Workers Sudbury Ontario Canada
| | - Paul Sampara
- The Occupational Health Clinics for Ontario Workers Sudbury Ontario Canada
| | - Donna Pearson
- The Occupational Health Clinics for Ontario Workers Sudbury Ontario Canada
| | - Janice Martell
- The Occupational Health Clinics for Ontario Workers Sudbury Ontario Canada
| | - Andrew M. Zarnke
- The Occupational Health Clinics for Ontario Workers Sudbury Ontario Canada
- Department of Kinesiology and Health Sciences, School of Kinesiology and Health Sciences Laurentian University Sudbury Ontario Canada
- Center for Research in Occupational Safety and Health Laurentian University Sudbury Ontario Canada
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18
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Lin NW, Maier LA. Occupational exposures and sarcoidosis: current understanding and knowledge gaps. Curr Opin Pulm Med 2022; 28:144-151. [PMID: 34698677 DOI: 10.1097/mcp.0000000000000835] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Sarcoidosis is an idiopathic granulomatous disease that primarily affects the lungs. Several lines of evidence suggest that occupational exposures are associated with disease risk. This review critically evaluates studies using the Bradford Hill criteria for causation to determine if a causal relationship can be established between occupational exposure and sarcoidosis. RECENT FINDINGS Large epidemiological studies have proposed multiple occupational exposures associated with sarcoidosis but lack consistency of results. Many convincing studies demonstrate an association between World Trade Center (WTC) dust and sarcoidosis, which illustrates a causal relationship based on the fulfillment of the Bradford Hill criteria. Studies describing an association between silica/metals and sarcoidosis are intriguing but fulfill a limited number of the Bradford Hill criteria and warrant further investigation before a causal relationship can be determined. Finally, we also discuss preliminary studies associating sarcoidosis phenotypes with specific occupational exposures. SUMMARY Using the Bradford Hill criteria for causation, we demonstrate that WTC dust has a causative relationship with sarcoidosis, which reinforces the theory that sarcoidosis is an exposure-related disease. More research is needed to determine other specific occupational exposures causing disease.
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Affiliation(s)
- Nancy W Lin
- Division of Pulmonary and Critical Care Sciences, Department of Medicine, School of Medicine
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, Colorado
| | - Lisa A Maier
- Division of Pulmonary and Critical Care Sciences, Department of Medicine, School of Medicine
- Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Aurora, Colorado
- Division of Environmental and Occupational Health Sciences, National Jewish Health, Denver, Colorado, USA
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19
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Vihlborg P, Pettersson H, Makdoumi K, Wikström S, Bryngelsson IL, Selander J, Graff P. Carpal Tunnel Syndrome and Hand-Arm Vibration: A Swedish National Registry Case-Control Study. J Occup Environ Med 2022; 64:197-201. [PMID: 34873137 PMCID: PMC8887848 DOI: 10.1097/jom.0000000000002451] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the increased risk for carpal tunnel syndrome (CTS) in men and women with hand-arm vibration (HAV) exposure. DESIGN Case-control study of CTS where 4396 cases was obtained from National Outpatient Register between 2005 through 2016. Cases were matched to controls and exposure was estimated using a job exposure matrix. RESULTS Exposure to HAV increased the risk of CTS with an OR of 1.61 (95% CI 1.46-1.77). The risk was highest in men <30 years of age and among women <30 years no increased risk was observed. The risk increased with a mean year exposure above 2.5 m/s2 to OR 1.84 (95% CI 1.38-2.46). CONCLUSIONS HAV exposure increase the risk of CTS in both genders, with highest risk increase in younger men. This emphasize identification of HAV exposure in patients with CTS.
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Affiliation(s)
- Per Vihlborg
- Department of Geriatrics and Odensbackens Health Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden (Dr Vihlborg); School of Medical Sciences, Örebro University, Örebro, Sweden (Dr Wikström); Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden (Dr Pettersson); Department of Ophthalmology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden (Dr Makdoumi); Center for Clinical Research and Education, County Council of Värmland, Sweden (Dr Wikström); Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden (Mr Bryngelsson); Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (Dr Selander); National Institute of Occupational Health (STAMI), Oslo, Norway (Dr Graff)
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20
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Wrangel O, Graff P, Bryngelsson IL, Fornander L, Wiebert P, Vihlborg P. Silica Dust Exposure Increases Risk for Rheumatoid Arthritis: A Swedish National Registry Case-Control Study. J Occup Environ Med 2021; 63:951-955. [PMID: 34091575 PMCID: PMC8562940 DOI: 10.1097/jom.0000000000002281] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Rheumatoid arthritis (RA) is an inflammatory disease with unknown etiology. This study examines if silica dust exposure increases the risk for seropositive and seronegative RA. METHODS A nationwide registry case-control study was conducted that included all cases of RA in Sweden between 2005 and 2016. In total, 31,139 cases with two matched controls were included. A JEM was used to estimate exposure. RESULTS Silica dust exposure was associated with a statistically significant increase in odds ratio (OR) for seropositive (OR 1.22, 95% CI 1.05 to 1.40) and seronegative (OR 1.23, 95% CI 1.04 to 1.46) RA among men. CONCLUSION This study found an increased OR for RA in silica-exposed men. The OR was equal for seropositive and seronegative RA. These findings further support the hypothesis that silica dust may be a trigger for RA.
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Affiliation(s)
- Oscar Wrangel
- Department of Occupational and Environmental Medicine, Faculty of Medicine and Health, Örebro University, Sweden (Mr Wrangel, Bryngelsson, Dr Fornander, and Dr Vihlborg); National Institute of Occupational Health (STAMI), Oslo, Norway (Dr Graff); Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden (Dr Wiebert); Centre for Occupational and Environmental Medicine, Region Stockholm, Sweden (Dr Wiebert); Department of Geriatrics, Faculty of Medicine and Health, Örebro University, Sweden (Dr Vihlborg)
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21
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Forest V, Pourchez J, Pélissier C, Audignon Durand S, Vergnon JM, Fontana L. Relationship between Occupational Exposure to Airborne Nanoparticles, Nanoparticle Lung Burden and Lung Diseases. TOXICS 2021; 9:toxics9090204. [PMID: 34564355 PMCID: PMC8473390 DOI: 10.3390/toxics9090204] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/23/2021] [Accepted: 08/27/2021] [Indexed: 01/13/2023]
Abstract
The biomonitoring of nanoparticles in patients’ broncho-alveolar lavages (BAL) could allow getting insights into the role of inhaled biopersistent nanoparticles in the etiology/development of some respiratory diseases. Our objective was to investigate the relationship between the biomonitoring of nanoparticles in BAL, interstitial lung diseases and occupational exposure to these particles released unintentionally. We analyzed data from a cohort of 100 patients suffering from lung diseases (NanoPI clinical trial, ClinicalTrials.gov Identifier: NCT02549248) and observed that most of the patients showed a high probability of exposure to airborne unintentionally released nanoparticles (>50%), suggesting a potential role of inhaled nanoparticles in lung physiopathology. Depending on the respiratory disease, the amount of patients likely exposed to unintentionally released nanoparticles was variable (e.g., from 88% for idiopathic pulmonary fibrosis to 54% for sarcoidosis). These findings are consistent with the previously performed mineralogical analyses of BAL samples that suggested (i) a role of titanium nanoparticles in idiopathic pulmonary fibrosis and (ii) a contribution of silica submicron particles to sarcoidosis. Further investigations are necessary to draw firm conclusions but these first results strengthen the array of presumptions on the contribution of some inhaled particles (from nano to submicron size) to some idiopathic lung diseases.
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Affiliation(s)
- Valérie Forest
- Centre CIS, Mines Saint-Etienne, Univ Lyon, Univ Jean Monnet, INSERM, U1059 Sainbiose, F-42023 Saint-Etienne, France;
- Correspondence:
| | - Jérémie Pourchez
- Centre CIS, Mines Saint-Etienne, Univ Lyon, Univ Jean Monnet, INSERM, U1059 Sainbiose, F-42023 Saint-Etienne, France;
| | - Carole Pélissier
- Department of Occupational Medicine, University Hospital of Saint-Etienne, F-42055 Saint-Etienne, France; (C.P.); (L.F.)
- Univ Lyon, Univ Eiffel, Univ Lyon 1, Univ St Etienne, IFSTTAR, UMRESTTE, UMR_T9405, F-42005 Saint-Etienne, France
| | - Sabyne Audignon Durand
- EPICENE Team, Inserm U1219, Bordeaux Population Health Research Center, University of Bordeaux, F-33076 Bordeaux, France;
- Department of Occupational and Environmental Medicine, Bordeaux Hospital, F-33400 Talence, France
| | - Jean-Michel Vergnon
- Univ Lyon, Univ Jean Monnet, INSERM, U1059 Sainbiose, F-42023 Saint-Etienne, France;
- Department of Chest Diseases and Thoracic Oncology, University Hospital of Saint-Etienne, F-42055 Saint-Etienne, France
| | - Luc Fontana
- Department of Occupational Medicine, University Hospital of Saint-Etienne, F-42055 Saint-Etienne, France; (C.P.); (L.F.)
- Univ Lyon, Univ Eiffel, Univ Lyon 1, Univ St Etienne, IFSTTAR, UMRESTTE, UMR_T9405, F-42005 Saint-Etienne, France
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22
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Ronsmans S, De Ridder J, Vandebroek E, Keirsbilck S, Nemery B, Hoet PHM, Vanderschueren S, Wuyts WA, Yserbyt J. Associations between occupational and environmental exposures and organ involvement in sarcoidosis: a retrospective case-case analysis. Respir Res 2021; 22:224. [PMID: 34372845 PMCID: PMC8351152 DOI: 10.1186/s12931-021-01818-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/01/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Sarcoidosis most commonly affects lungs and intrathoracic lymph nodes, but any other organ can be involved. In epidemiological studies, many occupational and environmental exposures have been linked to sarcoidosis but their relationship with the disease phenotype has barely been studied. OBJECTIVE To investigate how occupational and environmental exposures prior to diagnosis relate to organ involvement in patients with sarcoidosis METHODS: We retrospectively studied patients seen at a sarcoidosis clinic between 2017 and 2020. Patients were included if they had a clinical presentation consistent with sarcoidosis and histologically confirmed epithelioid granulomas or had Löfgren syndrome. In a case-case analysis using multivariable logistic regression we calculated odds ratios (OR) of prespecified exposure categories (based on expert ascertainment) for cases with a given organ involvement versus cases without this organ involvement. RESULTS We included 238 sarcoidosis patients. Sarcoidosis limited to pulmonary involvement was associated with exposure to inorganic dust prior to diagnosis (OR 2.11; 95% confidence interval [CI] 1.11-4.17). Patients with liver involvement had higher odds of contact with livestock (OR 3.68; 95% CI 0.91-12.7) or having jobs with close human contact (OR 4.33; 95% CI 1.57-11.3) than patients without liver involvement. Similar associations were found for splenic involvement (livestock: OR 4.94, 95% CI 1.46-16.1; close human contact: OR 3.78; 95% CI 1.47-9.46). Cardiac sarcoidosis was associated with exposure to reactive chemicals (OR 5.08; 95% CI 1.28-19.2) or livestock (OR 9.86; 95% CI 1.95-49.0). Active smokers had more ocular sarcoidosis (OR 3.26; 95% CI 1.33-7.79). CONCLUSIONS Our study indicates that, in sarcoidosis patients, different exposures might be related to different organ involvements-hereby providing support for the hypothesis that sarcoidosis has more than one cause, each of which may promote a different disease phenotype.
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Affiliation(s)
- Steven Ronsmans
- Clinic for Occupational and Environmental Medicine, Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Jolien De Ridder
- Unit for Interstitial Lung Diseases, Department of Respiratory Diseases, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Eline Vandebroek
- Clinic for Occupational and Environmental Medicine, Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
- Premed, External Service for Prevention and Protection at Work, Leuven, Belgium
| | - Stephan Keirsbilck
- Clinic for Occupational and Environmental Medicine, Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
- IDEWE, External Service for Prevention and Protection at Work, Leuven, Belgium
| | - Benoit Nemery
- Clinic for Occupational and Environmental Medicine, Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Peter H M Hoet
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Steven Vanderschueren
- Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium
- Laboratory of Clinical Infectious and Inflammatory Diseases, Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium
| | - Wim A Wuyts
- Unit for Interstitial Lung Diseases, Department of Respiratory Diseases, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department CHROMETA, KU Leuven, Leuven, Belgium
| | - Jonas Yserbyt
- Unit for Interstitial Lung Diseases, Department of Respiratory Diseases, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department CHROMETA, KU Leuven, Leuven, Belgium.
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Abstract
PURPOSE OF REVIEW Previous studies mainly described a role for organic agents as possible triggers for sarcoidosis. In this review, we address recent studies suggesting a possible role for inorganic elements, such as metals or silica in sarcoidosis pathogenesis. RECENT FINDINGS Several epidemiological papers suggest that inorganic agents, either by environmental exposures or occupational activities, could trigger sarcoidosis. Association between inorganics and sarcoidosis is also described in several recently published case reports and studies demonstrating immunological sensitization to inorganic agents in sarcoidosis patients.Studies comparing chronic beryllium disease (CBD) and sarcoidosis suggest that although antigenic triggers may differ, underlying processes may be comparable.Besides the fact that a growing number of studies show a possible role for inorganic triggers, it is also suggested that inorganic triggered sarcoidosis may result in a more severe phenotype, including pulmonary fibrosis. SUMMARY We can use the knowledge already gained on CBD pathogenesis to conduct further research into role of inorganics, such as metals and silica as antigens in sarcoidosis. Given the importance of a lymphocyte proliferation test (LPT) in diagnosing CBD, it seems obvious to also implement this test in the diagnostic work-up of sarcoidosis to identify patients with an inorganic antigenic trigger of their disease.
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Abstract
Epigenetic modifications are emerging as important regulatory mechanisms of gene expression in lung disease, given that they are influenced by environmental exposures and genetic variants, and that they regulate immune and fibrotic processes. In this review, we introduce these concepts with a focus on the study of DNA methylation and histone modifications and discuss how they have been applied to lung disease, and how they can be applied to sarcoidosis. This information has implications for other exposure and immunologically mediated lung diseases, such as chronic beryllium disease, hypersensitivity pneumonitis, and asbestosis.
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Affiliation(s)
- Iain R Konigsberg
- Human Medical Genetics and Genomics Program, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Dept of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lisa A Maier
- Dept of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Dept of Medicine, National Jewish Health, Denver, CO, USA
- Dept of Environmental and Occupational Health, Colorado School of Public Health, Aurora, CO, USA
| | - Ivana V Yang
- Human Medical Genetics and Genomics Program, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Dept of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Dept of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
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Oliver LC, Zarnke AM. Sarcoidosis: An Occupational Disease? Chest 2021; 160:1360-1367. [PMID: 34102140 PMCID: PMC8546237 DOI: 10.1016/j.chest.2021.06.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/12/2021] [Accepted: 06/02/2021] [Indexed: 11/30/2022] Open
Abstract
Sarcoidosis is an important member of the family of granulomatous lung diseases. Since its recognition in the late 19th century, sarcoidosis has been thought of as a disease of unknown cause. Over the past 20 years, this paradigm has been shifting, more rapidly in the past 10 years. Epidemiologic studies, bolstered by case reports, have provided evidence of causal associations between occupational exposure to specific agents and sarcoidosis. Pathogenesis has been more clearly defined, including the role of gene-exposure interactions. The use of in vitro lymphocyte proliferation testing to detect sensitization to inorganic antigens is being examined in patients with sarcoidosis. These antigens include silica and certain metals. Results of studies to date show differences in immunoreactivity of occupationally exposed sarcoidosis cases compared with control cases, suggesting that lymphocyte proliferation testing may prove useful in diagnosing work-related disease. This review discusses recently published findings regarding associations between occupational exposure to silica and silicates, World Trade Center dust, and metals and risk for sarcoidosis, as well as advances in the development of diagnostic tools. Not all cases of sarcoidosis have an identified cause, but some do. Where the cause is occupational, its recognition is critical to enable effective treatment through removal of the affected worker from exposure and to inform intervention aimed at primary prevention.
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Affiliation(s)
- L Christine Oliver
- Dalla Lana School of Public Health, Division of Occupational and Environmental Health, University of Toronto, Toronto, ON, Canada; The Occupational Health Clinics for Ontario Workers, Sudbury, ON, Canada.
| | - Andrew M Zarnke
- The Occupational Health Clinics for Ontario Workers, Sudbury, ON, Canada; Laurentian University, Sudbury, ON, Canada; Center for Research in Occupational Safety and Health, Sudbury, ON, Canada
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[Silica causes difficulties]. Rev Mal Respir 2021; 38:768-772. [PMID: 34023191 DOI: 10.1016/j.rmr.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 03/25/2021] [Indexed: 11/22/2022]
Abstract
Silicosis and sarcoidosis are two very distinct entities in the literature. All the additional non-invasive examinations, including the chest CT scan, often do not differentiate them. The history, including occupational exposure to identified silica particles, is a discriminating factor. However, due to the pathogenic power of silica, it would be possible to have the simultaneous development of these two pathologies in the same patient. To illustrate this situation, here is the case of a 62-year-old patient, who presented initially with a picture of dyspnea and productive cough. The chest CT showed micronodular peribronchovascular infiltrates and mediastinal lymphadenopathy. The other additional examinations did not find anything specific. In the diagnostic process, the patient had multiple endoscopic samples which did not make it possible to be conclusive on one or the other of these pathologies. He therefore underwent a surgical lung biopsy which revealed histological lesions compatible with the two pathologies. Recent studies suggest that inhaled particles, especially silica, could be responsible for the pattern of sarcoidosis. However, it is difficult to say whether, in this case, silica was responsible for the development of sarcoidosis.
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Haque M, Ahmed R, Akhter Q. Cement dust revelation and inflammatory response: Global health comportment with special consideration towards Bangladesh. ADVANCES IN HUMAN BIOLOGY 2021. [DOI: 10.4103/aihb.aihb_59_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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