scholarly journals A follow-up study of occupational styrene exposure and risk of autoimmune rheumatic diseases

2019 ◽  
Vol 77 (2) ◽  
pp. 64-69
Author(s):  
Signe Hjuler Boudigaard ◽  
Zara Ann Stokholm ◽  
Jesper Medom Vestergaard ◽  
Mette Skovgaard Mohr ◽  
Klaus Søndergaard ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Rheumatic Diseases ◽  
Time Windows ◽  
Solvent Exposure ◽  
Reinforced Plastics ◽  
Autoimmune Rheumatic Diseases ◽  
Exposure Response ◽  
Increased Risk ◽  
Styrene Exposure

ObjectivesIncreased risk has been suggested for autoimmune rheumatic diseases following solvent exposure. The evidence for specific solvents is limited, and little is known about exposure–response relations. Styrene is an aromatic, organic solvent and the objective of this study was to analyse the association between occupational styrene exposure and autoimmune rheumatic diseases in men and women.MethodsWe followed 72 212 styrene-exposed workers of the Danish reinforced plastics industry from 1979 to 2012. We modelled full work history of styrene exposure from employment history, survey data and historical styrene exposure measurements. We identified cases in the national patient registry and investigated gender-specific exposure–response relations by cumulative styrene exposure for different exposure time windows adjusting for age, calendar year and educational level.ResultsDuring 1 515 126 person-years of follow-up, we identified 718 cases of an autoimmune rheumatic disease, of which 73% were rheumatoid arthritis. When adjusting for potential confounders and comparing the highest with the lowest styrene exposure tertile, we observed a statistically non-significantly increased risk of systemic sclerosis among women (incidence rate ratio (IRR)=2.50; 95% CI 0.50 to 12.50) and men (IRR=1.86; 95 % CI 0.50 to 7.00), based on 9 and 22 cases, respectively. Results were inconsistent for the other autoimmune rheumatic diseases examined.ConclusionThis study suggests an association between occupational styrene exposure and systemic sclerosis in men as well as in women but based on few cases. This is a new finding and has to be replicated before conclusions can be drawn.

scholarly journals O2D.1 A follow-up study of occupational styrene exposure and risk of systemic sclerosis, rheumatoid arthritis, and other systemic autoimmune rheumatological diseases

2019 ◽  
Vol 76 (Suppl 1) ◽  
pp. A18.1-A18
Author(s):  
Signe Hjuler Boudigaard ◽  
Zara Ann Stokholm ◽  
Jesper Medom Vestergaard ◽  
Mette Skovgaard Mohr ◽  
Klaus Søndergaard ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Systemic Sclerosis ◽  
Lupus Erythematosus ◽  
Systemic Vasculitis ◽  
Time Windows ◽  
Systemic Lupus ◽  
Exposure Response ◽  
Increased Risk ◽  
Primary Systemic Vasculitis ◽  
Styrene Exposure

BackgroundIncreased risk of systemic sclerosis, systemic lupus erythematosus, rheumatoid arthritis, primary systemic vasculitis, and systemic Sjogren’s syndrome has been suggested following occupational solvent exposure. The evidence for specific solvents is, however, limited and little is known about exposure and risk patterns.AimOur aim is to examine the exposure response relation for systemic sclerosis, rheumatoid arthritis, systemic lupus erythematosus, primary systemic vasculitis, and systemic Sjogren’s syndrome following occupational styrene exposure.MethodsWe followed 72 467 styrene exposed workers of the Danish reinforced plastics industry from 1977–2012. We modelled styrene exposure from employment history, survey data and historical styrene exposure measurements. We identified cases in a national patient register, and investigated gender specific exposure response relations by cumulative styrene exposure for different exposure time windows adjusting for age, decade, educational level and a proxy for tobacco smoking.ResultsDuring 1,553,577 person-years, we identified 223 women and 453 men diagnosed with a systemic autoimmune rheumatological disease, of which three out of four were rheumatoid arthritis. When adjusting for potential confounders and comparing the highest with the lowest styrene exposure tertile, we observed a statistically non- significantly increased risk of systemic sclerosis among men (IRR=1.79; 95% CI 0.48–6.87) and women (IRR=2.58; 95% CI 0.51–12.94), based on 20 and 9 cases respectively. However, for women with systemic sclerosis, we saw a significantly increasing trend of 1.19 (1.01–1.40) pr. 100 mg/m3-years. Increased risks were also suggested for primary systemic vasculitis (IRR=2.32; 95% CI 0.63–8.52) and rheumatoid arthritis (IRR=1.26; 95% CI 0.95–1.67) among men. Analyses of exposure time windows suggest a latency period for rheumatoid arthritis of about 15 years.ConclusionThis study might indicate that styrene exposure is associated with the occurrence of systemic sclerosis among men and women, and primary systemic vasculitis and rheumatoid arthritis among men.

scholarly journals Sinonasal adenocarcinoma following styrene exposure in the reinforced plastics industry

2018 ◽  
Vol 75 (6) ◽  
pp. 412-414 ◽  
Author(s):  
Mette Schou Nissen ◽  
Zara Ann Stokholm ◽  
Mette Skovgaard Christensen ◽  
Vivi Schlünssen ◽  
Jesper Medom Vestergaard ◽  
...  
Keyword(s):  
Strong Association ◽  
Incidence Rates ◽  
Dust Exposure ◽  
Wood Dust ◽  
Reinforced Plastics ◽  
Exposure Response ◽  
Increased Risk ◽  
Sinonasal Adenocarcinoma ◽  
Styrene Exposure ◽  
High Level

BackgroundSinonasal adenocarcinoma is a rare disease expected to have rare causes and potential for strong risk factors as reflected by the strong association with occupational wood dust exposure. High level styrene exposure is a rare and suspected carcinogen, and this study examines the exposure–response relation between occupational styrene exposure, sinonasal adenocarcinoma and other subtypes.MethodsWe followed 73 092 styrene-exposed workers from 1968 to 2011 and identified sinonasal cancers in the Danish Cancer Registry. We modelled cumulative styrene exposure and estimated incidence rates and age, sex and wood-industry adjusted ORs.ResultsDuring 1 585 772 person-years, we observed nine cases of adenocarcinoma, corresponding to a fivefold non-significantly increased OR for estimates of high versus low cumulative styrene exposure (OR 5.11, 95% CI 0.58 to 45.12). The increased risk was confined to exposure received during the recent 15 years. The other histological subtypes showed no increased risk.ConclusionThis study suggests increased risk of sinonasal adenocarcinoma following styrene exposure. The observations are, however, few, confounding from wood dust exposure cannot be ruled out, and additional studies are needed before firm conclusions can be drawn.

scholarly journals Associations of Occupational Styrene Exposure With Risk of Encephalopathy and Unspecified Dementia: A Long-Term Follow-up Study of Workers in the Reinforced Plastics Industry

2020 ◽  
Author(s):  
Inge Brosbøl Iversen ◽  
Mette Skovgaard Mohr ◽  
Jesper Medom Vestergaard ◽  
Zara Ann Stokholm ◽  
Henrik Albert Kolstad
Keyword(s):  
Survival Function ◽  
Latency Period ◽  
Positive Trend ◽  
Solvent Exposure ◽  
Reinforced Plastics ◽  
Increased Risk ◽  
Styrene Exposure ◽  
Incident Cases ◽  
Plastics Industry

Abstract Exposure to industrial solvents has been associated with encephalopathy. Styrene is a neurotoxic industrial solvent, and we investigated the long-term risk of encephalopathy and unspecified dementia following styrene exposure. We followed 72,465 workers in the reinforced plastics industry in Denmark (1977–2011) and identified incident cases of encephalopathy (n = 228) and unspecified dementia (n = 565) in national registers. Individual styrene exposure levels were modeled from information on occupation, measurements of work place styrene levels, product, process, and years of employment. Adjusted analyses were performed using a discrete survival function. A positive trend for encephalopathy (P < 0.01) and a negative trend for unspecified dementia (P = 0.03) were seen with cumulative styrene exposure accrued during the recent period of up to 15 years. For unspecified dementia and the combination of unspecified dementia and encephalopathy, a positive trend was indicated when applying a 30-year exposure lag (P = 0.13 and P = 0.07). The risk patterns seen following recent exposure probably reflect diagnostic criteria for encephalopathy requiring recent industrial solvent exposure and referral bias rather than association with styrene exposure, while the increasing risk observed for unspecified dementia and the combination of encephalopathy and unspecified dementia following distant exposure indicates an increased risk of dementia following styrene exposure with a long latency period.

scholarly journals Association between Autoimmune Rheumatic Diseases and the Risk of Dementia

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Kang Lu ◽  
Hao-Kuang Wang ◽  
Chih-Ching Yeh ◽  
Chih-Yuan Huang ◽  
Pi-Shan Sung ◽  
...  
Keyword(s):  
Rheumatic Diseases ◽  
Proportional Hazard ◽  
Vascular Events ◽  
Autoimmune Rheumatic Diseases ◽  
Multiple Organs ◽  
Cox Proportional Hazard ◽  
Increased Risk ◽  
Cox Proportional Hazard Regression ◽  
Insurance Database

Aim. Autoimmune rheumatic diseases (ARD) are characterized by systemic inflammation and may affect multiple organs and cause vascular events such as ischemic stroke and acute myocardial infarction. However, the association between ARD and increased risk of dementia is uncertain. This is a retrospective cohort study to investigate and compare the risk of dementia between patients clinically diagnosed with ARD and non-ARD patients during a 5-year follow-up period.Methods. Data were obtained from the Longitudinal Health Insurance Database 2000 (LHID2000). We included 1221 patients receiving ambulatory or hospitalization care and 6105 non-ARD patients; patients were matched by sex, age, and the year of index use of health care. Each patient was studied for 5 years to identify the subsequent manifestation of dementia. The data obtained were analyzed by Cox proportional hazard regression.Results. During the 5-year follow-up period, 30 ARD (2.48%) and 141 non-ARD patients (2.31%) developed dementia. During the 5-year follow-up period, there were no significant differences in the risks of any type of dementia (adjusted hazard ratio (HR), 1.18; 95% CI, 0.79–1.76) in the ARD group after adjusting for demographics and comorbidities.Conclusions. Within the 5-year period, patients with and without ARD were found to have similar risks of developing dementia.

scholarly journals Surgical treatment of recalcitrant gastroesophageal reflux disease in patients with systemic sclerosis: a systematic review

2021 ◽  
Author(s):  
Alberto Aiolfi ◽  
Mario Nosotti ◽  
Kazuhide Matsushima ◽  
Carolina Perali ◽  
Cristina Ogliari ◽  
...  
Keyword(s):  
Systematic Review ◽  
Systemic Sclerosis ◽  
Surgical Treatment ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Current Data ◽  
Current Evidence ◽  
Increased Risk

Abstract Introduction Gastroesophageal reflux disease (GERD) is frequently seen in patients with systemic sclerosis (SSc). Long-standing GERD may cause esophagitis, long-segment strictures, and Barrett’s esophagus and may worsen pre-existing pulmonary fibrosis with an increased risk of end-stage lung disease. Surgical treatment of recalcitrant GERD remains controversial. The purpose of this systematic review was to summarize the current data on surgical treatment of recalcitrant GERD in SSc patients. Materials and methods A systematic literature review according to PRISMA and MOOSE guidelines. PubMed, EMBASE, and Web of Science databases were consulted. Results A total of 101 patients were included from 7 studies. The age ranged from 34 to 61 years and the majority were females (73.5%). Commonly reported symptoms were heartburn (92%), regurgitation (77%), and dysphagia (74%). Concurrent pulmonary disease was diagnosed in 58% of patients. Overall, 63 patients (62.4%) underwent open fundoplication, 17 (16.8%) laparoscopic fundoplication, 15 (14.9%) Roux en-Y gastric bypass (RYGB), and 6 (5.9%) esophagectomy. The postoperative follow-up ranged from 12 to 65 months. Recurrent symptoms were described in up to 70% and 30% of patients undergoing fundoplication and RYGB, respectively. Various symptoms were reported postoperatively depending on the type of surgical procedures, anatomy of the valve, need for esophageal lengthening, and follow-up. Conclusions The treatment of recalcitrant GERD in SSc patients is challenging. Esophagectomy should be reserved to selected patients. Minimally invasive RYGB appears feasible and safe with promising preliminary short-term results. Current evidence is scarce while a definitive indication about the most appropriate surgical treatment is lacking.

scholarly journals Increased Risk of Valvular Heart Disease in Systemic Sclerosis: An Underrecognized Cardiac Complication

2021 ◽  
pp. jrheum.201005
Author(s):  
Reto D. Kurmann ◽  
Edward A. El-Am ◽  
Yasser A. Radwan ◽  
Avneek S. Sandhu ◽  
Cynthia S. Crowson ◽  
...  
Keyword(s):  
Heart Disease ◽  
Systemic Sclerosis ◽  
Valvular Heart Disease ◽  
Cardiac Involvement ◽  
Significant Risk ◽  
Fold Increase ◽  
Significant Risk Factor ◽  
Increased Risk ◽  
Incident Cases

Objective Cardiac involvement is a poor prognostic marker in systemic sclerosis (SSc). While diastolic dysfunction, myocardial fibrosis, and arrhythmias are traditionally considered features of primary cardiac involvement in SSc, the incidence of valvular heart disease (VHD) is not well reported. Our objective was to examine the prevalence of VHD at time of SSc diagnosis and incidence of VHD during follow up compared to non-SSc subjects. Methods Medical records of patients with suspicion of SSc were reviewed to identify incident cases. SSc subjects were matched 1:2 by age- and sex to non-SSc subjects. Results The study included 78 incident SSc cases and 156 non-SSc comparators [56 years (± 15.7), 91% female]. A nearly 4-fold increase in the prevalence of moderate/severe VHD prior to SSc diagnosis compared to non-SSc subjects (6% vs. 0%; P=0.004) was identified. During follow up, 18 SSc and 12 non-SSc patients developed moderate/severe VHD. The cumulative incidence of VHD at 10 years after SSc incidence/index was 17.9% (95% CI: 10.7-29.9%) in patients with SSc compared with 2.3% (95% CI: 0.7-6.3%) in non-SSc subjects (HR: 4.23; 95% CI: 2.03-8.83). Coronary heart disease was the only significant risk factor for VHD. Conclusion SSc patients have a 4-fold increase in the prevalence of moderate/severe VHD at diagnosis compared to non-SSc patients. They also have a 4-fold increased risk of developing moderate/severe VHD after diagnosis of SSc. Aortic stenosis and mitral regurgitation have a much higher prevalence in SSc patients, besides secondary tricuspid regurgitation. Underlying mechanisms for this association require further elucidation.

Subclinical progression of systemic sclerosis-related cardiomyopathy

2020 ◽  
Vol 27 (17) ◽  
pp. 1876-1886
Author(s):  
Giulia Stronati ◽  
Lucia Manfredi ◽  
Alessia Ferrarini ◽  
Lucia Zuliani ◽  
Marco Fogante ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Systemic Sclerosis ◽  
Speckle Tracking ◽  
Cardiac Involvement ◽  
Global Longitudinal Strain ◽  
Prospective Longitudinal Study ◽  
Heart Involvement ◽  
Increased Risk ◽  
Prospective Longitudinal

Aims Cardiac involvement in patients with systemic sclerosis (SSc) is frequent and represents a negative prognostic factor. Recent studies have described subclinical heart involvement of both the right ventricle (RV) and left ventricle (LV) via speckle-tracking-derived global longitudinal strain (GLS). It is currently unknown if SSc-related cardiomyopathy progresses through time. Our aim was to assess the progression of subclinical cardiac involvement in patients with SSc via speckle-tracking-derived GLS. Methods This was a prospective longitudinal study enrolling 72 consecutive patients with a diagnosis of SSc and no structural heart disease nor pulmonary hypertension. A standard echocardiographic exam and GLS calculations were performed at baseline and at follow-up. Results Traditional echocardiographic parameters did not differ from baseline to 20-month follow-up. LV GLS, despite being already impaired at baseline, worsened significantly during follow-up (from –19.8 ± 3.5% to –18.7 ± 3.5%, p = .034). RV GLS impairment progressed through the follow-up period (from –20.9 ± 6.1% to –18.7 ± 5.4%, p = .013). The impairment was more pronounced for the endocardial layers of both LV (from –22.5 ± 3.9% to –21.4 ± 3.9%, p = .041) and RV (–24.2 ± 6.2% to –20.6 ± 5.9%, p = .001). A 1% worsening in RV GLS was associated with an 18% increased risk of all-cause death or major cardiovascular event ( p = .03) and with a 55% increased risk of pulmonary hypertension ( p = .043). Conclusion SSC-related cardiomyopathy progresses over time and can be detected by speckle-tracking GLS. The highest progression towards reduced deformation was registered for the endocardial layers, which supports the hypothesis that microvascular dysfunction is the main determinant of heart involvement in SSc patients and starts well before overt pulmonary hypertension.

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