Department of Rheumatology, St Vincent's Hospital Melbourne, Melbourne, Victoria.
Department of Medicine, The University of Melbourne at St Vincent's Hospital (Melbourne), Fitzroy, Victoria.
Rheumatology (Oxford). 2020 Dec 1;59(12):3900-3905. doi: 10.1093/rheumatology/keaa446.
To determine the frequency of self-reported occupational exposure to silica in SSc patients enrolled in the Australian Scleroderma Cohort Study, and to compare the disease characteristics of the silica-exposed patients with those of the non-exposed patients.
Data collected over a 12-year period from 1670 SSc patients were analysed. We compared the demographic and clinical characteristics of those who reported occupational silica exposure with those who did not. A subgroup analysis of male patients was performed, as well as a multivariable analysis of correlates of silica exposure.
Overall, 126 (7.5%) of the cohort reported occupational silica exposure. These individuals were more likely to be male (73 of 231, i.e. 31.6% males exposed) and to have worked in mining and construction industries. Those who reported silica exposure were younger at the onset of SSc skin involvement [odds ratio (OR) 0.9, P = 0.02], of male gender (OR 14.9, P < 0.001), have joint contractures (OR 1.8, P = 0.05) and have higher physical disability as defined by scleroderma HAQ (OR 1.4, P = 0.01).
The highest percentage of silica exposure was found in males. These patients were more likely to have the presence of certain clinical manifestations and Scl-70 antibody, which is known to confer a poor prognosis. These findings support the association between occupational silica exposure and the subsequent development of SSc. Further investigation is required to describe the range of clinical manifestations and disease course, including prognosis and treatment response, in those diagnosed with occupationally induced SSc compared with idiopathic SSc.
确定纳入澳大利亚硬皮病队列研究的系统性硬化症（SSc）患者中自我报告职业性二氧化硅暴露的频率，并比较暴露组与未暴露组患者的疾病特征。
对 1670 例 SSc 患者在 12 年期间收集的数据进行分析。我们比较了报告职业性二氧化硅暴露与未报告职业性二氧化硅暴露患者的人口统计学和临床特征。对男性患者进行亚组分析，并对二氧化硅暴露的相关因素进行多变量分析。
总体而言，队列中有 126 例（7.5%）报告职业性二氧化硅暴露。这些人更可能是男性（231 例中有 73 例，即 31.6%的男性暴露），并且从事矿业和建筑业。报告二氧化硅暴露的患者在 SSc 皮肤受累发病时年龄较小[优势比（OR）0.9，P=0.02]，为男性（OR 14.9，P<0.001），有关节挛缩（OR 1.8，P=0.05），根据硬皮病 HAQ 定义的身体残疾程度较高（OR 1.4，P=0.01）。
二氧化硅暴露的最高比例出现在男性中。这些患者更有可能出现某些临床表现和 Scl-70 抗体，这已知与预后不良相关。这些发现支持职业性二氧化硅暴露与随后发生的 SSc 之间的关联。需要进一步调查，以描述在与特发性 SSc 相比，诊断为职业性 SSc 的患者的临床表现和疾病过程范围，包括预后和治疗反应。
