Asbestosis and systemic lupus erythematosus

Our plain-English summary of Asbestosis and systemic lupus erythematosus, by P. Bartsch, J. Salmon, P. Mahieu (International Archives of Allergy and Applied Immunology, 1980).

The study

• Authors: P. Bartsch, J. Salmon, P. Mahieu
• Journal: International Archives of Allergy and Applied Immunology
• Published: 1980;61(1):28-31
• Type of article: Case report
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 000786).

Abstract

A case associating asbestosis and clinical lupus erythematosus (SLE), both diagnosed according to standard criteria, is described. It is suggested that such an association may bear some analogy to the well-known 'Caplan-Collinet' syndrome, associating silicosis and rheumatoid arthritis.

In plain English

This case report from the State University of Liège, Belgium, described one 40-year-old man diagnosed with both asbestosis and systemic lupus erythematosus (SLE). For the previous 3 years he had worked on a bucket dredger on the River Meuse. Every 2 weeks he cut asbestos cardboard to replace steam-engine joints, work he said made a lot of dust. From November 1975 he developed joint pain, weight loss, fever and finger-tip skin ulcers. Blood tests showed a low white cell count and strongly positive antinuclear and anti-DNA antibodies. A lung biopsy showed interstitial fibrosis and an asbestos body. His chest X-ray showed a diffuse micronodular pattern that the authors said differed from usual asbestosis. After cyclophosphamide and methylprednisolone he quickly became symptom-free, though his chest X-ray was unchanged in December 1977. The authors stated that, as far as they knew, no such case had been described before. They suggested it could be a particular expression of immune reactions reported in many asbestos workers, possibly analogous to Caplan-Collinet syndrome (silicosis with rheumatoid arthritis).

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (one patient)
• Who was studied: One 40-year-old man with no previous medical history, a smoker of 25 cigarettes a day, seen at the Department of Medicine, State University of Liège, Belgium. His illness began in November 1975.
• Exposure: For the last 3 years, while working on a bucket dredger on the River Meuse, he replaced all the joints of the dredger's steam engine every 2 weeks. He did this by cutting asbestos cardboard into shape, which he said made a lot of dust. Before that he had worked 6 years in a cattle-food factory. No fiber type is given.
• Main results:
  • Symptoms: shoulder joint pain spreading to other joints, a 6 kg weight loss over a few weeks, fever, grade I breathlessness, and skin ulcers at the finger-tips.
  • Blood tests showed a low white cell count (2,700/mm³). Antinuclear antibodies and anti-DNA antibodies were strongly positive. The authors judged the findings strongly suggestive of SLE.
  • Lung function tests showed normal lung volumes but reduced diffusion, at 61% of normal.
  • A transbronchial lung biopsy from the right upper lobe showed interstitial fibrosis and an asbestos body. This was the basis for the asbestosis diagnosis.
  • The chest X-ray showed a diffuse micronodular pattern. The authors said this differed from that of pulmonary asbestosis because nodular shadows predominated and were concentrated in the upper lobes.
  • After treatment with cyclophosphamide (150 mg/day) and methylprednisolone (48 mg/day), the patient rapidly became symptom-free. At the time of writing he was well on methylprednisolone 4 mg/day only. His chest X-ray on December 19th, 1977 was unchanged.
  • Anti-DNA antibody levels peaked on January 30th, and none was detectable from February 16th. Rheumatoid factor was present only from February 18th. After treatment, the immune-complex (C1q binding) test became negative and C3 levels were normal on March 29th.
• The authors' conclusion: The authors stated that, as far as they knew, this was the first described case of SLE with asbestosis. They suggested it could be a particular clinical expression of the immune reaction to asbestos dust that has been shown in a wide proportion of asbestos workers. They also suggested it may bear some analogy to the Caplan-Collinet syndrome, which links silicosis and rheumatoid arthritis.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis.

Medical terms in this study, explained in our Lexicon: Silicosis.

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