Immunology and asbestosis

Our plain-English summary of Immunology and asbestosis, by M. Turner-Warwick (Proceedings of the Royal Society of Medicine, 1973).

The study

• Author: M. Turner-Warwick
• Journal: Proceedings of the Royal Society of Medicine
• Published: 1973;66(9):927-30
• Cited by: 19 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 nos. 002411, 002412).

Abstract

The prevalence of antinuclear antibody and rheumatoid factor has been studied in three series of subjects exposed under different conditions to asbestos dust. A greater incidence of ANA and rheumatoid factor was found in the Pneumoconiosis Medical Panel series, where the majority of subjects had abnormal chest radiographs, in contrast to a near normal incidence in the East Ham and Medical Research Unit series, where the majority had no clinical or radiographic evidence of asbestos-induced lung disease.

The increased prevalence of ANA appears to be related to the development of asbestosis and not to heavy exposure of asbestos dust alone. The absence of ANA and rheumatoid factor in certain other fibrosing lung diseases suggests that the appearance of these autoantibodies is not the nonspecific consequence of any form of pulmonary fibrosis.

Studies in vitro have shown that in asbestosis patients with circulating antinuclear antibody evidence of lymphocyte sensitization can also frequently be found, though of lesser degree than is seen in patients with nonoccupational cryptogenic fibrosing alveolitis who present with a very similar clinical appearance.

Whether ANA can be used to identify individual susceptibility before the development of disease, or whether it influences the evolution of the pathology, will have to be determined from follow-up studies.

PubMed has no abstract for this study. This is the authors' abstract, copied from the article.

In plain English

This paper, presented at a 1972 meeting, summarized three surveys of 782 asbestos workers. The author asked whether certain autoantibodies, mainly antinuclear antibody (ANA) and rheumatoid factor, differed between groups of exposed workers. The groups were 196 people referred for pension assessment by the Pneumoconiosis Medical Panel, most with abnormal chest X-rays; 252 East Ham factory workers; and 334 naval personnel in Plymouth. Most in the last two groups had normal or near-normal X-rays. Fiber types were not specified. ANA was found in 20% of the pension group, 7.5% at East Ham and 8.4% at Plymouth. Rheumatoid factor was found in 11.7%, 5.3% and 3.6%. Among heavily exposed workers with finger clubbing, ANA rates were similar across the three groups: 30.3%, 25.0% and 33.3%. In a small selected group of ANA-positive asbestosis patients, lymphocyte tests showed no greater average response than in controls, although some individuals did respond. The author concluded that ANA appeared related to developing asbestosis rather than to heavy exposure alone. The author noted that exposure intensity was only approximate and that it was unresolved whether the antibodies contribute to the disease or result from it.

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: Summary of three systematic serological and clinical surveys of asbestos-exposed workers (conference paper)
• Who was studied: 782 asbestos workers in three series: 196 referred to the Pneumoconiosis Medical Panel for pension assessment (1968 to 1972, most with abnormal chest radiographs); 252 East Ham factory workers (serum collected 1969 to 1971, most with normal or slightly abnormal radiographs); 334 naval personnel, Royal Naval Dockyard, Plymouth (1968 to 1971, most with virtually normal radiographs)
• Exposure: Asbestos dust, with no fiber types specified. Approximate intensity was judged by job. Heavy: laggers, strippers, sprayers and those handling raw dry fibre. Light: those working nearby but not handling asbestos, wet fibre workers and those handling finished products. Medium: intermediate amounts.
• Main results:
  • Antinuclear antibody (ANA) was found in 39 (20%) of the Pneumoconiosis Medical Panel series, 19 (7.5%) of the East Ham series and 28 (8.4%) of the Plymouth (MRU) series
  • Rheumatoid factor was found in 23 (11.7%) of the Panel series, 13 (5.3%) of East Ham and 12 (3.6%) of the Plymouth series
  • ANA and rheumatoid factor were found in the same serum in only 14 of the 782 subjects
  • In the Panel series, increased ANA prevalence was also found in younger age groups. In the other two series, the increase was mainly in older subjects.
  • Finger clubbing with or without rales was found in 25% of the Panel series, 11.4% of East Ham and 9.3% of the Plymouth series
  • Among heavily exposed workers with clubbing with or without rales, ANA was present in 13/43 (30.3%) of the Panel series, 3/12 (25.0%) of East Ham and 7/21 (33.3%) of the Plymouth series
  • Among heavily exposed workers with neither clubbing nor rales, ANA was present in 2/27 (7.4%) of the Panel series, 3/75 (4.0%) of East Ham and 10/93 (10.7%) of the Plymouth series
  • In an initial survey of 55 Panel cases, most ANA-positive cases had moderate or marked radiographic abnormality
  • ANA-positive asbestosis patients as a group showed no greater inhibition of leukocyte migration (a test of lymphocyte sensitization) to nuclear antigens than controls, though individual patients showed sensitization
  • Lung-reactive autoantibodies were not significantly more common than in random populations
• The authors' conclusion: The author concluded that the increased prevalence of ANA appears related to the development of asbestosis, not to heavy exposure to asbestos dust alone. Whether ANA can identify susceptibility before disease develops, or influences its course, awaits follow-up studies.
• Limitations the authors state:
  • Exposure intensity was only approximate, based on the type of job held
  • Lymphocyte studies were done on a small number of selected ANA-positive patients
  • Whether the autoantibodies result from fibrosis or are involved in causing it was unresolved
  • The full radiographic analysis had not yet been completed

Topics

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

Medical terms in this study, explained in our Lexicon: Pneumoconiosis, Chest X-Ray, Pulmonary Fibrosis, Pathology.

Related studies

• Asbestosis and systemic lupus erythematosus — P. Bartsch, J. Salmon, et al. (1980)
• Radiographic progression of asbestosis: preliminary report — A. Gregor, R.W. Parkes, et al. (1979)
• Circulating rheumatoid and antinuclear factors in asbestos workers — M. Turner-Warwick, W.R. Parkes (1970)
• Immunology. How frustration leads to inflammation — L.A. O'Neill (2008)
• Circulating immune complexes in asbestos workers — J.J. Zone, W.N. Rom (1985)
• Lymphocyte responses to phytohaemagglutinin in patients with asbestosis and pleural mesothelioma — P.L. Haslam, A. Lukoszek, et al. (1978)

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