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      Epidemiology of organic solvents and connective tissue disease

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          Abstract

          Case reports suggest that solvents are associated with various connective tissue diseases (systemic sclerosis, scleroderma, undifferentiated connective tissue disease, systemic lupus erythematosis, and rheumatoid arthritis), particularly systemic sclerosis. A small number of epidemiological studies have shown statistically significant but weak associations between solvent exposure, systemic sclerosis, and undifferentiated connective tissue disease. However, the interpretation of these positive findings is tempered by a lack of replication, an inability to specify which solvents convey risk, and an absence of increasing risk with increasing exposure. Existing studies, on aggregate, do not show conclusively that solvents (either as a group of chemicals or individual chemicals) are causally associated with any connective tissue disease. Further investigations should be carried out to replicate the positive existing findings and to specify the solvents and circumstances of exposure that carry risk.

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          Most cited references93

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          Epidemiology of systemic sclerosis (scleroderma).

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            Is occupational organic solvent exposure a risk factor for scleroderma?

            The primary objective was to determine whether occupational exposure to organic solvents is related to an increased risk of systemic sclerosis (SSc; scleroderma). Occupational histories were obtained from 178 SSc patients and 200 controls. Exposure scores were computed for each individual using job exposure matrices, which were validated by an industrial expert. Among men, those with SSc were more likely than controls to have a high cumulative intensity score (odds ratio [OR] 2.9, 95% confidence interval [95% CI] 1.1-7.6) and a high maximum intensity score (OR 2.9, 95% CI 1.2-7.1) for any solvent exposure. They were also more likely than controls to have a high maximum intensity score for trichloroethylene exposure (OR 3.3, 95% CI 1.0-10.3). Among men and women, significant solvent-disease associations were observed among SSc patients who tested positive for the anti-Scl-70 autoantibody; these trends were not observed among the men and women who tested negative for anti-Scl-70. These results provide evidence that occupational solvent exposure may be associated with an increased risk of SSc.
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              Silica-induced scleroderma.

              In a survey done in East Germany between 1981 and 1988, we found that 93 of 120 male scleroderma patients had long-term exposure to silica dust. We describe our findings in 12 patients with scleroderma and silicosis. The exposure time to silica dust was between 3 and 34 years; the interval between the beginning of exposure and the onset of scleroderma averaged 27.3 years (range 9 to 40 years). Antinuclear antibodies in titers between 80 and 10,240 with nucleolar and/or speckled patterns were found in 10 patients, antibodies against double-stranded DNA in three, Scl-70 (topoisomerase I) in three, and anticentromere antibodies in five. The following markers of collagen metabolism were increased in serum: beta-galactosidase in 12 patients, laminin peptide-P1 in 10 patients, N-terminal procollagen type III peptide in 10, and urinary sialic acid excretion in 7. We propose that crystalline particles of silica less than 5 microns may be phagocytosed by macrophages and release lymphokines and monokines, which activate fibroblasts and enhance their collagen and glycosaminoglycan synthesis. In addition, silica may act as an adjuvant to increase immune reactivity.
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                Author and article information

                Journal
                Arthritis Res
                Arthritis Research
                BioMed Central (London )
                1465-9905
                1465-9913
                2000
                1 December 1999
                : 2
                : 1
                : 5-15
                Affiliations
                [1 ]University of Michigan, School of Public Health, Ann Arbor, Michigan, USA
                Article
                ar65
                10.1186/ar65
                129987
                11094414
                39adf7c6-ee46-40cb-bf8e-74f089f4aff7
                Copyright © 2000 Current Science Ltd
                History
                : 11 October 1999
                : 13 October 1999
                : 20 October 1999
                : 27 October 1999
                Categories
                Review

                Orthopedics
                petroleum distillates,systemic sclerosis,occupation,scleroderma,solvents
                Orthopedics
                petroleum distillates, systemic sclerosis, occupation, scleroderma, solvents

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