Servicio de Neumoloxía, Hospital Álvaro Cunqueiro, Complexo Hospitalario Universitario de Vigo, Spain; IRIDIS Group (Investigation in Rheumatology and Immuno-Mediated Diseases) del Instituto de Investigación Sanitaria Galicia Sur, Vigo, Spain.
Servicio de Neumoloxía, Hospital Álvaro Cunqueiro, Complexo Hospitalario Universitario de Vigo, Spain.
Arch Bronconeumol. 2021 Sep;57(9):571-576. doi: 10.1016/j.arbr.2021.06.003. Epub 2021 Jul 17.
Silicosis is associated with an increased risk of developing systemic autoimmune rheumatic disease (SARD). The prognostic implications of this association are poorly characterized. The aim of this study was to determine the prevalence of SARD and autoimmune markers in a cohort of patients with exposure to silica and assess their impact on prognosis.
We performed a prospective observational study of all patients attending the dedicated silicosis clinic of our pulmonology unit between 2009 and December 2017. Diagnosis was confirmed by a rheumatologist according to Spanish Rheumatology Society criteria. Autoimmune markers, pulmonary function tests, radiological progression, visits to the emergency department and primary care center, and hospital admissions for respiratory causes, and mortality were analyzed.
Overall, 489 cases of silicosis and 95 cases of exposure were studied. In total, 54 (11.0%) patients with silicosis had SARD: 12 (2.4%) rheumatoid arthritis, 10 (2.0%) systemic lupus erythematosus, 10 (2.0%) systemic sclerosis, 3 (0.6%) Sjögren syndrome, 2 (0.4%) vasculitis associated with anti-neutrophil cytoplasmic antibodies (ANCA +), 6 (1.2%) psoriatic arthritis, 3 (0.6%) ankylosing spondylitis, and 8 (1.6%) other autoimmune diseases with no special features. The patients with SARD visited the emergency room more often (63.0% vs. 42.5%; p = 0.004), and progressed more rapidly (22.2 vs. 11.7%; p = 0.030).
The presence of systemic rheumatic autoimmune diseases involves radiological progression and a higher clinical impact.
矽肺与发生系统性自身免疫性风湿性疾病（SARD）的风险增加有关。这种关联的预后意义尚不清楚。本研究的目的是确定接触二氧化硅的患者队列中 SARD 和自身免疫标志物的患病率，并评估其对预后的影响。
我们对 2009 年至 2017 年 12 月期间在我们的肺病学部门专门的矽肺诊所就诊的所有患者进行了前瞻性观察研究。诊断由风湿病学家根据西班牙风湿病学会标准确认。分析了自身免疫标志物、肺功能测试、放射学进展、急诊和初级保健中心就诊、因呼吸原因住院以及死亡率。
共有 489 例矽肺和 95 例接触病例进行了研究。共有 54 例矽肺患者（11.0%）患有 SARD：12 例（2.4%）类风湿关节炎，10 例（2.0%）系统性红斑狼疮，10 例（2.0%）系统性硬化症，3 例（0.6%）干燥综合征，2 例（0.4%）抗中性粒细胞胞质抗体（ANCA +）相关血管炎，6 例（1.2%）银屑病关节炎，3 例（0.6%）强直性脊柱炎，8 例（1.6%）其他无特殊特征的自身免疫性疾病。患有 SARD 的患者更频繁地就诊于急诊室（63.0%比 42.5%；p=0.004），且放射学进展更快（22.2%比 11.7%；p=0.030）。
系统性风湿性自身免疫疾病的存在涉及放射学进展和更高的临床影响。
