Systemic Sclerosis and Occupational Risk Factors: Role of Solvents and Cleaning Products

ANNE MAÎTRE, MARTINE HOURS, VINCENT BONNETERRE, JOËLLE ARNAUD, MARIE TÜLIN ARSLAN, PATRICK CARPENTIER, ALAIN BERGERET, and RÉGIS DE GAUDEMARIS

ABSTRACT.

Objective. To analyze occupational and non-occupational exposure factors suspected of being associated with scleroderma (SSc), with a view to inculpating or excluding certain potentially toxic substances (e.g., solvents), thereby contributing to the recognition of such toxins in the field of occupational health.

Methods. The study comprised 10 men and 83 women diagnosed with SSc between 1995 and 1999 (American College of Rheumatology criteria) and early SSc, and 206 age and sex matched controls. The SSc registry is all-inclusive in the French administrative departments of Isère and Savoie so controls were randomly selected from the general population (using telephone directories) in these departments to ensure full representation. Exposure factors were analyzed for each subject by a personal questionnaire, and an individual evaluation was carried out by an industrial expert. Data were analyzed by conditional logistical regression adjusting for educational level.

Results. Construction workers were at significantly higher risk of contracting SSc; odds ratio (OR) = 4.01 (95% confidence interval 1.14-14.09). Analysis by industrial experts identified exposure to certain toxic substances regularly used by these same workers as risk factors for SSc: cleaning products: OR = 1.66 (0.90-3.08) (both sexes) and OR = 1.71 (0.92-3.20) (women only); solvents: OR = 3.23 (1.58-6.63) (both sexes) and OR = 2.80 (1.28-6.11) (women only); synthetic adhesives: OR 25.36 (1.36-472.28) (on 3 exposed cases).

Conclusion. Exposure to either cleaning products or solvents emerged as a risk factor for SSc. Exposure factors should be characterized and results of all studies compared to implement appropriate preventive measures in relevant workplaces. (J Rheumatol 2004;31:2395-401)

Key Indexing Terms:

SCLERODERMA
SYSTEMIC SCLEROSIS
OCCUPATIONAL EXPOSURE
SOLVENTS
CLEANING PRODUCTS

---

From the Environnement et Prédiction de la Santé Des Populations — Laboratoire, Faculté de Médecine, Domaine de la Merci, La Tronche; Unité Mixte de Recherche Epidémiologique Transport Travail Environnement, Université Claude Bernard, Lyon; Laboratoire de Médecine Vasculaire, CHU Grenoble, Grenoble, France.

Supported in part by PHRC-CHU de Grenoble, France.

A. Maître, PhD, Environnement et Prédiction de la Santé Des Populations — Laboratoire, Faculté de Médecine, Domaine de la Merci; M. Hours, PhD, Unité Mixte de Recherche Epidémiologique Transport Travail Environnement, Université Claude Bernard; V. Bonneterre, MD; J. Arnaud, MD, Environnement et Prédiction de la Santé Des Populations — Laboratoire, Faculté de Médecine, Domaine de la Merci; M.T. Arslan, Unité Mixte de Recherche Epidémiologique Transport Travail Environnement, Université Claude Bernard; P. Carpentier, MD, Laboratoire de Médecine Vasculaire, CHU Grenoble; A. Bergeret, MD, Unité Mixte de Recherche Epidémiologique Transport Travail Environnement, Université Claude Bernard; R. de Gaudemaris, MD, Environnement et Prédiction de la Santé Des Populations — Laboratoire, Faculté de Médecine, Domaine de la Merci.

Address reprint requests to Professor R. de Gaudemaris, Equipe Médecine et Santé au Travail EPSP, Laboratoire TIMC UMR 5525, Faculté de Médecine, Domaine de la Merci 38706 La Tronche Cedex, France. E-mail: RDegaudemaris@chu-grenoble.fr

Submitted November 5, 2003; revision accepted June 23, 2004.

---