Rheumatology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Botucatu, São Paulo, SP, 740 CEP 04023 900, Brazil.
Clin Rheumatol. 2022 Nov;41(11):3275-3283. doi: 10.1007/s10067-022-06274-0. Epub 2022 Jul 7.
Autoimmune/autoinflammatory syndrome induced by adjuvants (ASIA) was first described in 2011 to cover disorders characterized by dysregulation of the immune system after exposure to an adjuvant. In the present review, the authors focus on silicone-induced ASIA. In the last two decades, there has been worldwide increase in the use of silicone breast implant (SBI) as an aesthetic procedure, raising concerns for possible effects on the immune system, especially in people who already have previous immune dysregulation. The authors did a critical review of the most important articles referring to silicone-induced ASIA, including most recent studies regarding physiopathologic mechanism. Despite large-scale epidemiological studies conducted to assess the association between SBI and autoimmune/rheumatic disorders, the results remain inconclusive, and the debate over the safety of SBIs remains heated. The explantation of silicone breast has been indicated for silicone-induced ASIA with improvement of unspecific symptoms in the majority of patients; however, the outcome seems different in patients with definitive autoimmune rheumatic disease (AIRD). There is no prospective study evaluating the risk of flares after SBI in patients who already have an AIRD. Therefore, based on the literature, we cannot contraindicate the procedure; however, we need to advertise about the risk of ASIA to the patients with AIRD. Long-term safety and implant-related outcomes should be discussed with these patients, considering each case individually, assessing genetic and environmental factors, and determining if the autoimmune disease is in remission or not, for shared decision among patient and the physician.
佐剂诱导的自身免疫/炎症综合征（ASIA）于 2011 年首次被描述，用于涵盖接触佐剂后免疫系统失调为特征的疾病。在本综述中，作者重点介绍了硅酮诱导的 ASIA。在过去的二十年中，全球范围内硅酮乳房植入物（SBI）作为一种美容手术的使用有所增加，这引起了人们对其可能对免疫系统产生影响的担忧，尤其是对那些已经存在先前免疫失调的人。作者对涉及硅酮诱导的 ASIA 的最重要的文章进行了批判性回顾，包括最近关于病理生理机制的研究。尽管进行了大规模的流行病学研究来评估 SBI 与自身免疫/风湿性疾病之间的关联，但结果仍不确定，关于 SBIs 安全性的争论仍很激烈。对于硅酮诱导的 ASIA，已表明应将硅酮乳房植入物取出，大多数患者的非特异性症状会得到改善；然而，对于明确的自身免疫性风湿病（AIRD）患者，结果似乎不同。目前还没有前瞻性研究评估已经患有 AIRD 的患者在 SBI 后是否会出现病情加重的风险。因此，根据文献，我们不能将该手术作为禁忌症；但是，我们需要向患有 AIRD 的患者宣传 ASIA 的风险。应与这些患者讨论长期安全性和与植入物相关的结果，根据每个病例进行个别评估，考虑遗传和环境因素，并确定自身免疫性疾病是否处于缓解期，以便在医患之间做出共同决策。
