Rheumatology and Clinical Immunology Unit, ASST Spedali Civili of Brescia, and Department of Clinical and Experimental Sciences, University of Brescia, Italy.
Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital and Scientific Institute, Milan, and Vita-Salute San Raffaele University, Milan, Italy.
Clin Exp Rheumatol. 2021 Jul-Aug;39 Suppl 131(4):25-28. doi: 10.55563/clinexprheumatol/mg0paj. Epub 2020 Dec 2.
Systemic sclerosis (SSc) is a heterogeneous systemic autoimmune disease with distinct subsets identified by specific autoantibodies. Some environmental agents might play a role in SSc pathogenesis, including silicone breast implants (SBI). This association has been controversial in previous literature and only few studies reported the auto-antibody status in these SSc women. The objective of this study was to evaluate the association of SBI with SSc in a large cohort of Italian patients, classified according to their SSc-related autoantibodies and to their history of breast cancer.
Three Italian referral centres retrospectively collected clinical and laboratory data of consecutive SSc women, that were included when fulfilling the 2013 ACR/EULAR criteria and when SSc specific auto-antibodies status was available (anti-centromere (ACA), anti-Topoisomerase I (anti-Topo I) and anti-RNA Polymerase III antibodies (anti-RNAP3)). Data regarding history of SBI, SBI rupture and breast cancer were recorded.
Among 742 SSc women, a history of SBI was recorded in 12 patients (1.6%); in only 1 case the implantation occurred after SSc diagnosis. In SSc patients with anti- RNAP3+ a significantly higher frequency of SBI rupture and SBI rupture without breast cancer were observed, as compared to anti-RNAP3-negative patients. No association was noted for SBI without rupture.
In this study we demonstrated a link between SBI rupture and induction of anti-RNAP3+ SSc; further studies are needed to better define the characteristics of this syndrome and the possible effects of SBI removal and immunosuppressive treatment.
系统性硬化症（SSc）是一种异质性的系统性自身免疫性疾病，根据特定的自身抗体可分为不同亚型。一些环境因素可能在 SSc 的发病机制中起作用，包括硅树脂乳房植入物（SBI）。之前的文献中对此相关性存在争议，仅有少数研究报道了这些 SSc 女性的自身抗体状态。本研究的目的是在意大利的一个大样本队列中评估 SBI 与 SSc 的相关性，该队列根据 SSc 相关自身抗体和乳腺癌病史进行分类。
三个意大利转诊中心回顾性收集了连续 SSc 女性的临床和实验室数据，这些女性符合 2013 年 ACR/EULAR 标准，且 SSc 特异性自身抗体状态可用（抗着丝点（ACA）、抗拓扑异构酶 I（抗 Topo I）和抗 RNA 聚合酶 III 抗体（抗 RNAp3））。记录了有关 SBI 史、SBI 破裂和乳腺癌的信息。
在 742 名 SSc 女性中，有 12 名（1.6%）患者有 SBI 史；仅 1 例在 SSc 诊断后发生。与抗 RNAp3 阴性患者相比，抗 RNAp3+ SSc 患者中 SBI 破裂和 SBI 破裂伴无乳腺癌的发生率明显更高。未观察到无破裂的 SBI 与 SSc 之间的相关性。
在这项研究中，我们证明了 SBI 破裂与抗 RNAp3+ SSc 的发生之间存在关联；需要进一步的研究来更好地定义这种综合征的特征以及 SBI 切除和免疫抑制治疗的可能效果。
