Abstract: Relationship Between Occupational Risk Factors and Severity Markers of Systemic Sclerosis

Relationship Between Occupational Risk Factors and Severity Markers of Systemic Sclerosis

JULIE MAGNANT, MICHÈLE DE MONTE, JEAN-LOUIS GUILMOT, GÉRARD LASFARGUES, PATRICE DIOT, ELISABETH ASQUIER, DANIELLE DEGENNE, ERIC BOISSINOT, and ELISABETH DIOT

ABSTRACT.

Objective. To investigate a potential association between occupational risk factors and severity markers of systemic sclerosis (SSc) defined by diffuse cutaneous extent, pulmonary involvement, and immunologic profile, i.e., presence of antitopoisomerase I antibody (anti-topo I).

Methods. Occupational exposures were assessed in 105 patients with SSc from 1998 to 2002. Exposures to silica dust, welding fumes, solvents, and epoxy resins were investigated. A group of 39 exposed SSc patients and a group of 66 unexposed ones were identified and compared according to severity markers of SSc. The stage of cutaneous extent was defined according to the classification of Leroy, as limited scleroderma (lSSc) or diffuse scleroderma (dSSc). Respiratory status was defined by pulmonary function tests and high resolution computed tomography. Immunological profile was determined by the presence of anti-topo I or anticentromere antibodies (ACA). Statistical relationships between occupational exposures and severity markers of SSc were evaluated using a multiple correspondence analysis and Fisher's exact test.

Results. Diffuse scleroderma affected mainly patients exposed during their occupational life to toxic agents. There were significant or close to significant associations between toxic exposure and dSSc (p = 0.06), pulmonary involvement (p = 0.10), and negative ACA (p = 0.03). The most incriminated products seemed to be epoxy resins (p = 0.06), white spirit (p = 0.07), aromatic solvents (p = 0.07), and silica coupled to welding fumes (p = 0.10).

Conclusion. Our results indicate that occupational toxic factors have an influence on the severity of SSc. (J Rheumatol 2005;32:1713-8)

Key Indexing Terms:

OCCUPATIONAL DISEASE
SCLERODERMA
SEVERITY FACTORS

From the Groupe de Pneumologie, INSERM U618, IFR 135; Service de Médecine Interne B; Institut de Médecine du Travail du Val de Loire; Groupement d'Imagerie Médicale; and Laboratoire d'Immunologie, CHU Bretonneau, Tours, France.

J. Magnant Jr, MD, Groupe de Pneumologie, INSERM U618, IFR 135, Service de Médecine Interne B; M. de Monte, PhD, Groupe de Pneumologie; J.L. Guilmot, MD, Service de Médecine Interne B; G. Lasfargues, MD, PhD, Service de Médecine Interne B, Institut de Médecine du Travail du Val de Loire; P. Diot, MD, PhD, Groupe de Pneumologie; E. Asquier, MD, Groupement d'Imagerie Médicale; D. Degenne, PharmD, Laboratoire d'Immunologie; E. Boissinot, MD, Groupe de Pneumologie; E. Diot, MD, PhD, Groupe de Pneumologie, Service de Médecine Interne B.

Address reprint requests to Dr. E. Diot, Groupe de Pneumologie, INSERM U618, IFR 135, CHU Bretonneau, 2 bd Tonnellé, F-37044 Tours Cedex 1, France. E-mail: ediot@med.univ-tours.fr

Accepted for publication April 20, 2005.