Prospective study to evaluate the association between systemic sclerosis and occupational exposure and review of the literature

Fetal programming and systemic sclerosis

“…With regard to the occupational histories of patients and control subjects, particular attention was given to exposure to crystalline silica, organic solvents, welding fumes, epoxy resins, and pesticides. 19 To minimize recall bias and ensure the validity of the approach, the data that were collected were compared with the data recorded in the clinical charts, even if this was possible only in 40 of the patients (12%) and 24 of the control subjects (10%) because of a lack of available records, especially in the case of older subjects. Moreover, the interview was repeated 1 month later in a randomized group of 40 patients and 40 control subjects to assess the level of uncertainty that had been attributed to recall.…”

“…The exclusion criteria for both patients and control subjects were refusal to participate, the presence of chronic diseases (such as coronary heart disease and related disorders, stroke, hypertension, and type 2 diabetes mellitus 14 ), and occupation-related SSc risk factors (in particular organic solvents, silica, white spirit, welding fumes, and epoxy resins). 19 Furthermore, the presence of other autoimmune diseases was an exclusion criterion for patients with SSc; the presence of any autoimmune disease was an exclusion criterion for control subjects. The Regional Center of Rare Diseases of the Meyer Children's Hospital, University of Florence, developed the research protocol, supervised the data collection and performed the statistical data analysis.…”

“…19 It is clear that prematurity or intrauterine growth retardation are not limited to conditioning health in the short-term but can cause various diseases over the long-term, which include hypertension, diabetes mellitus, obesity, and heart disease; we can add SSc, which is part of the broader spectrum of autoimmune rheumatic diseases, to this list.…”

“…38 As proof of this, alterations in DNA methylation, histone code modifications, and changes in microRNA expression levels have been observed in different cell lines (fibroblasts, lymphocytes, and endothelial cells) of patients with SSc. 39,40 One of the main recognized environmental risk factors for SSc remains exposure to silica, but other occupational factors 19 and viral agents 41 could also contribute to SSc pathogenesis. Finally, it is now wellknown that endothelial cell injury is an early event in SSc pathogenesis, and abnormal vasoreactivity is thought to result from endothelial cell malfunction, with an imbalance favoring vasoconstriction.…”

Incidence and prevalence of Systemic Sclerosis (SSc) in Poland – differences between rural and urban regions

“…The occurrence of SSc-like disease in response to certain environmental agents and the possible relationship of SSc to environmental exposures, suggest that certain triggers lead to variable disease expression in genetically-susceptible hosts. SSc has been associated with occupational exposures to crystalline silica, white spirit, aromatic solvents, chlorinated solvents, trichlorethylene, ketones and welding fumes [2]. Associations of these agents with SSc appear to be more marked in those with high cumulative exposure, and the association between SSc and occupational exposures may be variable according to gender [2].…”