Rheumatoid Arthritis Associated with Characteristic Chest X-ray Appearances in Coal-workers

Miall, W. E.; Caplan, Anthony; Cochrane, A. L.; Kilpatrick, G. S.; Oldham, P. D.

doi:10.1136/bmj.2.4848.1231

Cited by 96 publications

(48 citation statements)

References 11 publications

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“…In the 1950s, Caplan (1953) first described unusual radiologic changes in the lungs of Welsh coal miners who had pneumoconiosis. In a subsequent study of these miners, Miall et al (1953) found that the rheumatoid lesions in the lung were predictive for rheumatoid arthritis (subsequently called Caplan's syndrome). Since that time many studies have examined the link between crystalline silica exposure and development of autoimmune diseases (Parks et al 1999).…”

Section: Discussionmentioning

confidence: 99%

Silica exposure and systemic vasculitis.

Mulloy

2003

Environ Health Perspect

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Work in Department of Energy (DOE) facilities has exposed workers to multiple toxic agents leading to acute and chronic diseases. Many exposures were common to numerous work sites. Exposure to crystalline silica was primarily restricted to a few facilities. I present the case of a 63-year-old male who worked in DOE facilities for 30 years as a weapons testing technician. In addition to silica, other workplace exposures included beryllium, various solvents and heavy metals, depleted uranium, and ionizing radiation. In 1989 a painful macular skin lesion was biopsied and diagnosed as leukocytoclastic vasculitis. By 1992 he developed gross hematuria and dyspnea. Blood laboratory results revealed a serum creatinine concentration of 2.1 mg/dL, ethrythrocyte sedimentation rate of 61 mm/hr, negative cANCA (antineutrophil cytoplasmic antibody cytoplasmic pattern), positive pANCA (ANCA perinuclear pattern), and antiglomerular basement membrane negative. Renal biopsy showed proliferative (crescentric) and necrotizing glomerulonephritis. The patient's diagnoses included microscopic polyangiitis, systemic necrotizing vasculitis, leukocytoclastic vasculitis, and glomerulonephritis. Environmental triggers are thought to play a role in the development of an idiopathic expression of systemic autoimmune disease. Crystalline silica exposure has been linked to rheumatoid arthritis, scleroderma, systemic lupus erythematosus, rapidly progressive glomerulonephritis and some of the small vessel vasculitides. DOE workers are currently able to apply for compensation under the federal Energy Employees Occupational Illness Compensation Program (EEOICP). However, the only diseases covered by EEOICP are cancers related to radiation exposure, chronic beryllium disease, and chronic silicosis.

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Section: Discussionmentioning

confidence: 99%

Silica exposure and systemic vasculitis.

Mulloy

2003

Environ Health Perspect

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“…Occupational groups studied include miners (25)(26)(27)(28)30,32,44,45), granite workers and stonemasons (24,46), and workers in a scouring powder factory (29). These studies include clinical descriptions of silica-exposed cases, estimates of the incidence or prevalence in exposed workers, case-control comparisons within an occupational cohort, or comparisons with disease rates in the general population.…”

Section: Silica Dust and Autoimmune Diseasementioning

confidence: 99%

Occupational exposure to crystalline silica and autoimmune disease.

Parks

Conrad

Cooper

1999

Environ Health Perspect

243

102

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Occupational exposure to silica dust has been examined as a possible risk factor with respect to several systemic autoimmune diseases, including scleroderma, rheumatoid arthritis, systemic lupus erythematosus, and some of the small vessel vasculitidies with renal involvement (e.g., Wegener granulomatosis). Crystalline silica, or quartz, is an abundant mineral found in sand, rock, and soil. High-level exposure to respirable silica dust can cause chronic inflammation and fibrosis in the lung and other organs. Studies of specific occupational groups with high-level silica exposure (e.g., miners) have shown increased rates of autoimmune diseases compared to the expected rates in the general population. However, some clinic- and population-based studies have not demonstrated an association between silica exposure and risk of autoimmune diseases. This lack of effect may be due to the limited statistical power of these studies to examine this association or because the lower- or moderate-level exposures that may be more common in the general population were not considered. Experimental studies demonstrate that silica can act as an adjuvant to nonspecifically enhance the immune response. This is one mechanism by which silica might be involved in the development of autoimmune diseases. Given that several different autoimmune diseases may be associated with silica dust exposure, silica dust may act to promote or accelerate disease development, requiring some other factor to break immune tolerance or initiate autoimmunity. The specific manifestation of this effect may depend on underlying differences in genetic susceptibility or other environmental exposures.

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“…In the study of Calvert GM et al [10], the link between crystalline silica exposure and RA is well demonstrated. Both RA and rheumatoid factor is more frequent in patients with Caplan's syndrome compared to exposed miners with or without simple pneumoconiosis [11].…”

Section: Discussionmentioning

confidence: 99%