Circulating rheumatoid and antinuclear factors in asbestos workers

Our plain-English summary of Circulating rheumatoid and antinuclear factors in asbestos workers, by M. Turner-Warwick, W.R. Parkes (British Medical Journal, 1970).

The study

• Authors: M. Turner-Warwick, W.R. Parkes
• Journal: British Medical Journal
• Published: 1970;3(5721):492-5
• Cited by: 127 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 001417).

Abstract

In an unselected series of 80 patients with asbestos exposure referred to the London Pneumoconiosis Medical Panel, antinuclear and rheumatoid factors were found in 28 and 27% respectively. This probably represents at least a fourfold increase over their incidence in random populations. The presence of these autoantibodies was not related to the duration of exposure, but was related to the extent of radiographic abnormality.

In plain English

The authors tested blood from an unselected series of 80 people with a history of asbestos exposure referred to the Pneumoconiosis Medical Panel in London, looking for two autoantibodies: antinuclear factors and rheumatoid factors. One or both factors were found in 38 of the 80 (47.5%). Antinuclear factors were found in 23 of 80 (28.8%), and the authors gave the rheumatoid factor rate as 27%. Only one of 12 people with virtually no chest X-ray shadowing had antibodies, compared with 37 of 68 (54%) with definite X-ray abnormality. In a control series of 113 asbestos workers with normal chest X-rays, three (2.6%) had antinuclear factors. Of 19 patients followed for five years, all six with antibodies showed X-ray progression, against four of 13 without. The authors concluded that the antibodies were not related to length of exposure but appeared to correlate with more severe, and possibly progressive, lung changes. They noted that lung tissue was unavailable and that asbestosis could not be reliably distinguished from cryptogenic fibrosing alveolitis.

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: Cross-sectional laboratory (blood antibody) study of referred patients, compared with chest X-ray findings, plus a control series and a small follow-up comparison; lab tests were done blind to clinical details
• Who was studied: 80 people with a history of asbestos exposure referred to the Pneumoconiosis Medical Panel in London, not all of whom were accepted by the Panel as having asbestosis. The control series was 113 asbestos workers of similar sex, age and exposure duration with normal chest X-rays.
• Exposure: Exposure to asbestos dust; the article does not name fiber types or specific jobs. In the group with antibodies, exposure duration ranged from 1 to 46 years.
• Main results:
  • Antinuclear or rheumatoid factors, or both, were found in 38 (47.5%) of the 80 patients.
  • Antinuclear factors were found in 23 of 80 sera (28.8%; printed as 28-8% because of scanning damage).
  • Antinuclear factor was mostly of the IgM type: IgM alone in eight sera and mixed IgG and IgM in 14.
  • 17 patients had positive differential agglutination test titres of 1:16 or greater, and 11 of these also had positive latex tests. The authors gave their series' rheumatoid factor rate as 27%.
  • Polyarthritis was present in four of the 17 patients with positive differential agglutination test titres.
  • Of 12 patients with virtually no pleural or lung shadowing on X-ray, one had antibodies. Of 68 patients with definite X-ray abnormality, 37 (54%) had antinuclear or rheumatoid factors or both.
  • Honeycombing on X-ray was seen equally often in patients with and without antibodies.
  • In the control series of 113 asbestos workers with normal chest X-rays, three (2.6%) had antinuclear factors.
  • Among 19 patients followed for five years, all six with antibodies showed X-ray progression, compared with four of the 13 without antibodies.
• The authors' conclusion: The authors concluded that the antibodies were not related to duration of exposure but appeared to correlate with more severe and possibly progressive lung changes. Because severe lung changes were also seen without antibodies, they considered the antibodies neither directly responsible for the lung changes nor likely to be a non-specific result of lung destruction.
• Limitations the authors state:
  • Lung tissue was not available, so asbestosis was defined by exposure history and X-ray appearance.
  • Cryptogenic fibrosing alveolitis occurring by chance in an asbestos worker could not be reliably distinguished from asbestosis.
  • Not all of the patients studied were accepted by the Panel as having asbestosis.
  • Five patients with only a weak positive latex test were counted as negative because the significance of such results is doubtful.
  • The analysis of disease progression was described as preliminary and involved only 19 patients.

Topics

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

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Pneumoconiosis.

Related studies

• An epidemiological survey of immunological abnormalities in asbestos workers. I. Nonorgan and organ-specific autoantibodies — A. Lange (1980)
• Rheumatoid factor in serum of individuals exposed to asbestos — B. Pernis, E.C. Vigliani, et al. (1965)
• Circulating immune complexes in asbestos workers — J.J. Zone, W.N. Rom (1985)
• Outcome of asbestos exposure (lung fibrosis and antinuclear antibodies) with respect to skin reactivity: an 8-year longitudinal study — A. Lange, D. Garncarek, et al. (1986)
• Association of Agricultural, Occupational, and Military Inhalants With Autoantibodies and Disease Features in US Veterans With Rheumatoid Arthritis — A.V. Ebel, G. Lutt, et al. (2021)
• Increased incidence of DNA double-strand breaks and anti-ds DNA antibodies in blood of workers occupationally exposed to asbestos — B. Marczynski, A.B. Czuppon, et al. (1994)

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