High prevalence of occupational exposure to solvents or silica in male systemic sclerosis patients: a Belgian cohort analysis

Our plain-English summary of High prevalence of occupational exposure to solvents or silica in male systemic sclerosis patients: a Belgian cohort analysis, by E. De Decker, M. Vanthuyne, D. Blockmans, et al (Clinical Rheumatology, 2018).

The study

• Authors: E. De Decker, M. Vanthuyne, D. Blockmans, F. Houssiau, J. Lenaerts, R. Westhovens, B. Nemery, E. De Langhe
• Journal: Clinical Rheumatology
• Published: 2018;37(7):1977-1982
• Cited by: 36 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Increasing evidence supports a relation of some occupational exposures to systemic sclerosis pathogenesis. We aimed to evaluate occupational exposure and clinical characteristics in male patients with systemic sclerosis followed in two Belgian academic hospitals. One hundred and three male patients, included in the Belgian Systemic Sclerosis Cohort, were identified. An expert in occupational medicine reviewed the occupational history and allocated the patients to one of the following groups: probable exposure to crystalline silica, probable exposure to solvents, probable exposure to other toxins, or no suspected occupational exposure. Clinical characteristics were extracted from the Belgian Systemic Sclerosis Cohort database. Sufficient data were available for 96/103 patients. Most of these male patients (70/96, 72.9%) had a history of occupational exposure, 55 patients were likely exposed to crystalline silica, 11 patients to solvents, 2 patients to both silica and solvents, and 2 patients to asbestos. Only 26 patients had no suspected occupational exposure (27.1%). We noticed a significant difference in smoking status between exposed and non-exposed patients, with the highest percentage of ever smokers in the group with solvent exposure (p = 0.011). We found no significant differences in disease phenotype between exposed and non-exposed patients. However, we noted a trend to a higher prevalence of anti-Scl70 antibodies, cardiac dysfunction, and higher disease activity score in patients with occupational exposure. We observed a strikingly high prevalence of occupational exposure to both silica and solvents in male systemic sclerosis patients. Occupational exposure to silica or solvents is highly prevalent in male systemic sclerosis patients.

In plain English

This Belgian brief report examined workplace exposures in men with systemic sclerosis. The authors studied 103 male patients in the Belgian Systemic Sclerosis Cohort treated at two academic hospitals from 2006 to 2015. Of these, 96 had enough job information to analyse. An occupational medicine expert judged from each work history whether the man had probable exposure to crystalline silica, solvents or asbestos. Of the 96 men, 70 (72.9%) had a history of occupational exposure: 55 probably to silica, 11 to solvents, 2 to both, and 2 to asbestos. The 2 asbestos-exposed men were too few to analyse separately. Exposed men were more often past or current smokers than the 26 men in white-collar jobs (84.4% versus 53.8%, p = 0.003). In exposed men, anti-Scl70 antibodies and diastolic heart dysfunction were more common and the average disease activity score was higher, but none of these differences was statistically significant. The authors concluded that male patients with systemic sclerosis have a high prevalence of occupational exposure to silica or solvents. They noted the lack of a control group and of a standardized exposure questionnaire, and that smoking could be a confounding factor.

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: exploratory analysis of male patients in a multicenter prospective patient registry (brief report), without a control group
• Who was studied: 103 male systemic sclerosis patients (all white Europeans) in the Belgian Systemic Sclerosis Cohort, under care at University Hospital Leuven and Cliniques Universitaires Saint-Luc between 2006 and 2015; 7 were excluded for insufficient occupational information, leaving 96
• Exposure: Probable occupational exposure to crystalline silica (construction-related jobs, glass industry, concrete, sandblasting, foundry metal work, mining), to solvents (paint industry, white spirit, trichloroethylene, petroleum), or to asbestos (2 patients; fiber type not stated), judged by an expert review of occupational histories
• Main results:
  • 70 of 96 male patients (72.9%) had a history of occupational exposure
  • 55 patients (57.3%) had probable exposure to crystalline silica
  • 11 patients (11.5%) had probable exposure to solvents; 2 (2.1%) had combined silica and solvent exposure
  • 2 patients had probable asbestos exposure
  • Because there were only 2 of them, the asbestos-exposed patients were not included in the subgroup analysis by type of exposure
  • 26 patients (27.1%) had white-collar jobs without occupational exposure
  • Patients with blue-collar jobs were more often ever-smokers than those with white-collar jobs (Table 2: 59 of 70, 84.4%, versus 14 of 26, 53.8%; p = 0.003)
  • Ever-smoking was 90.9% in the solvent-exposed group, 81.8% in the silica-exposed group and 53.8% in the no-exposure group (p = 0.011)
  • Anti-Scl70 antibodies were found in 34 of 70 blue-collar patients versus 7 of 26 white-collar patients (p = 0.067, not statistically significant)
  • Exposed patients had a higher mean disease activity score, 2.5 versus 1.5 (p = 0.055, not statistically significant)
  • Diastolic dysfunction was found in 32 of 70 blue-collar patients versus 6 of 26 white-collar patients (p = 0.060, not statistically significant)
  • No significant differences in cardiopulmonary involvement were seen between patients with and without suspected occupational exposure
  • Solvent-exposed patients were older (mean age 62) than silica-exposed (57) and unexposed (58) patients (p = 0.045)
• The authors' conclusion: The authors concluded that male patients with systemic sclerosis have a high prevalence of occupational exposure to silica or solvents
• Limitations the authors state:
  • Exposure was not assessed with a standardized questionnaire covering the nature, probability, intensity, frequency and duration of exposure, so no exposure score could be calculated
  • There was no control group
  • The difference in smoking status could be a confounding factor

Topics

Medical terms in this study, explained in our Lexicon: Occupational Exposure, Occupational History, Crystalline.

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