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Vol. 57. Issue 9.
Pages 571-576 (September 2021)
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Vol. 57. Issue 9.
Pages 571-576 (September 2021)
Original Article
DOI: 10.1016/j.arbr.2021.06.003
Prevalence and clinical impact of systemic autoimmune rheumatic disease in patients with silicosis
Prevalencia e impacto clínico de las enfermedades reumatológicas autoinmunitarias sistémicas en pacientes con silicosis
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José Jesús Blanco-Péreza,b,
Corresponding author
, Victoria Arnalich-Montiela, Ángel Salgado-Barreirac, María Angel Alvarez-Moured, Adriana Carolina Caldera-Díazd, Rafael Melero-Gonzaleze, Abel Pallarés-Sanmartína, Alberto Fernandez-Villara, Francisco Javier González-Barcalaf
a Servicio de Neumoloxía, Hospital Álvaro Cunqueiro, Complexo Hospitalario Universitario de Vigo, Spain
b IRIDIS Group (Investigation in Rheumatology and Immuno-Mediated Diseases) del Instituto de Investigación Sanitaria Galicia Sur, Vigo, Spain
c Unidad de Metodología y Estadística, Instituto de Investigación Sanitaria Galicia Sur, Vigo, Spain
d Servicio de Radiología, Hospital Álvaro Cunqueiro, Complexo Hospitalario Universitario de Vigo, Spain
e Servicio de Reumatología, Hospital Álvaro Cunqueiro de Vigo, Complexo Hospitalario Universitario de Vigo, Spain
f Servicio de Neumoloxía, Complexo Hospitalario Universitario de Santiago de Compostela, Spanish Biomedical Research Networking Centre-CIBERES, A Coruña, Spain
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Tables (4)
Table 1. Characteristics of patients with silicosis with and without SARD.
Table 2. Autoantibodies in exposed individuals without silicosis and in patients with silicosis.
Table 3. Radiological progression by presence of SARD.
Table 4. Visits to emergency department, primary care, hospitalization, and mortality.
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Abstract
Background

Silicosis is associated with an increased risk of developing systemic autoimmune rheumatic disease (SARD). The prognostic implications of this association are poorly characterized. The aim of this study was to determine the prevalence of SARD and autoimmune markers in a cohort of patients with exposure to silica and assess their impact on prognosis.

Method

We performed a prospective observational study of all patients attending the dedicated silicosis clinic of our pulmonology unit between 2009 and December 2017. Diagnosis was confirmed by a rheumatologist according to Spanish Rheumatology Society criteria. Autoimmune markers, pulmonary function tests, radiological progression, visits to the emergency department and primary care center, and hospital admissions for respiratory causes, and mortality were analyzed.

Results

Overall, 489 cases of silicosis and 95 cases of exposure were studied. In total, 54 (11.0%) patients with silicosis had SARD: 12 (2.4%) rheumatoid arthritis, 10 (2.0%) systemic lupus erythematosus, 10 (2.0%) systemic sclerosis, 3 (0.6%) Sjögren syndrome, 2 (0.4%) vasculitis associated with anti-neutrophil cytoplasmic antibodies (ANCA +), 6 (1.2%) psoriatic arthritis, 3 (0.6%) ankylosing spondylitis, and 8 (1.6%) other autoimmune diseases with no special features. The patients with SARD visited the emergency room more often (63.0% vs. 42.5%; p = 0.004), and progressed more rapidly (22.2 vs. 11.7%; p = 0.030).

Conclusions

The presence of systemic rheumatic autoimmune diseases involves radiological progression and a higher clinical impact.

Keywords:
Silicosis
Systemic autoimmune rheumatic disease
Sclerosis
Systemic lupus erythematous
Rheumatoid arthritis
Resumen
Introducción

La silicosis se asocia a un aumento del riesgo de padecer una de las enfermedades reumatológicas autoinmunes sistémicas (ERAS), aunque no se conocen las implicaciones clínicas de esta asociación. El objetivo del estudio es determinar la prevalencia de ERAS y de marcadores de autoinmunidad en una cohorte de pacientes con exposición a inhalación de polvo de sílice y evaluar su impacto clínico.

Método

Estudio observacional prospectivo en pacientes atendidos en una consulta monográfica de silicosis desde 2009 hasta diciembre 2017. El diagnóstico de ERAS se confirmó por un especialista en Reumatología según criterios de la Sociedad Española de Reumatología. Se analizaron marcadores de autoinmunidad, pruebas de función respiaratoria, progresión radiológica e impacto clínico medido por visitas a Atención Primaria, a Servicio de Urgencias, ingresos hospitalarios por causa respiratoria y mortalidad.

Resultados

Se estudiaron 489 casos de silicosis y 95 de exposición a inhalación de polvo de sílice sin silicosis. De los pacientes con silicosis, 54 (11,0%) tenían ERAS: 12 (2,4%) artritis reumatoide, 10 (2,0%) lupus eritematoso sistémico, 10 (2,0%) esclerosis sistémica, 6 (1,2%) artritis psoriásica, 3 (0,6%) Síndrome de Sjögren, 2 (0,4%) vasculitis asociada a anticuerpos anticitoplasma de neutrófilos, 3 (0,6%) espondiloartritis y 8 (1,6%) enfermedad autoinmune sin características específicas. Los pacientes con ERAS realizaron más visitas a urgencias (63,0% vs. 42,5%; p = 0,004), y experimentaron mayor progresión (22,2 vs. 11,7%; p = 0,030).

Conclusiones

Los pacientes con silicosis presentan una prevalencia de ERAS elevada y su presencia se asocia a una mayor progresión radiológica y un mayor impacto clínico.

Palabras clave:
Silicosis
Enfermedad reumática autoimmune sistémica
Esclerosis
Lupus eritematosos sistémico
Artritis reumatoide

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