Andreoli Laura, Tincani Angela
Department of Clinical and Experimental Sciences, University of Brescia, and Rheumatology and Clinical Immunology Unit, Spedali Civili of Brescia, Brescia, Italy.
Curr Opin Rheumatol. 2017 Jul;29(4):355-360. doi: 10.1097/BOR.0000000000000392.
The aim of this study was to discuss the role of environmental factors in the induction and perpetuation of autoimmunity, with particular focus on undifferentiated connective tissue disease (UCTD) and fibromyalgia. These two entities may share undefined clinical and laboratory features and recognize environmental exposures as triggering factors. From this particular point of view, both UCTD and fibromyalgia may resemble the picture of the 'Autoimmune/Inflammatory Syndrome Induced by Adjuvants' (ASIA).
A case-control study on environmental exposures showed that patients with UCTD were significantly more exposed to several adjuvants (vaccines, metal implants, proximity to metal factories and foundries) than age and sex-matched healthy controls. UCTD exposed to major ASIA triggers (vaccines, silicone) displayed typical features of ASIA (general weakness, chronic fatigue, irritable bowel syndrome) in the context of a predisposing genetic background (familiarity for autoimmunity).
The induction and perpetuation of autoimmunity is a complex process that requires the interaction between the individual genetic background and the environment. Environmental factors are gaining increasing attention since the description of ASIA, a syndrome that includes symptoms typically seen in patients with fibromyalgia and UCTD. A recent case-control study focusing on environmental exposures suggested that nearly half of patients with UCTD may fall within the ASIA spectrum.
本研究旨在探讨环境因素在自身免疫性疾病的诱发和持续发展中的作用，尤其关注未分化结缔组织病（UCTD）和纤维肌痛。这两种疾病可能具有一些尚不明确的临床和实验室特征，并将环境暴露视为触发因素。从这一特定角度来看，UCTD和纤维肌痛可能类似于“佐剂诱导的自身免疫/炎症综合征”（ASIA）的表现。
一项关于环境暴露的病例对照研究表明，与年龄和性别匹配的健康对照相比，UCTD患者显著更多地暴露于多种佐剂（疫苗、金属植入物、靠近金属工厂和铸造厂）。在具有遗传易感性背景（自身免疫性疾病家族史）的情况下，暴露于主要ASIA触发因素（疫苗、硅酮）的UCTD患者表现出ASIA的典型特征（全身无力、慢性疲劳、肠易激综合征）。
自身免疫性疾病的诱发和持续发展是一个复杂的过程，需要个体遗传背景与环境之间的相互作用。自从ASIA综合征被描述以来，环境因素越来越受到关注，ASIA综合征包括纤维肌痛和UCTD患者常见的症状。最近一项关注环境暴露的病例对照研究表明，近一半的UCTD患者可能属于ASIA谱系。
