Inorganic Dust Exposure During Military Service as a Predictor of Rheumatoid Arthritis and Other Autoimmune Conditions

Abstract

Objective. Rheumatoid arthritis (RA) and other autoimmune (AI) conditions are associated with inorganic dust exposure. Many military activities are likely to entail inorganic dust exposures. We wished to identify associations between prior military dust exposure and RA and other AI conditions.Methods. We studied persons from a roster of Army, Navy, Air Force, or Marine Corps personnel who had served in Operation Enduring Freedom and Operations Iraqi Freedom and New Dawn. We linked military occupational codes to a job exposure matrix assigning dust exposure likelihood. We used the Veterans Affairs Health Care System (VAHCS) electronic health care records to identify cases of RA, systemic lupus erythematosus (SLE), systemic sclerosis (SSc), vasculitis, and inflammatory myositis. Generalized estimating equations modeled risk of RA and other AI conditions associated with dust exposure, taking into account military service branch, age at first VAHCS encounter, sex, race/ ethnicity, smoking status, and years of military service.Results. Of 438 086 veterans (68% ever-smokers), 44% were classified with likely or somewhat likely dust exposure. Cases included 1139 cases with RA, 467 cases with SLE, and 180 cases with other AI diseases (SSc, vasculitis, or inflammatory myositis). Military dust exposure was associated with increased odds of RA (odds ratio [OR] = 1.10; 95% confidence interval [CI] = 1.003-1.20) and increased odds of SSc, vasculitis, or inflammatory myositis (OR = 1.23; 95% CI = 1.14-1.34) but was protective for SLE (OR = 0.81; 95% CI = 0.76-0.88). Conclusion.Dust exposure during past military service comprises an occupational and environmental risk factor for RA and other AI diseases. This is potentially relevant for prevention activities.

Dusty trades and associated rheumatoid arthritis in a population-based study in the coal mining counties of Appalachia

“…In summary, this analysis supports and amplifies our previous findings of a strong association between coal mining and other silica-exposing dust trades in Appalachia and RA, taking into account age, smoking and occupational ergonomic risks, the latter being largely overlooked as a cofactor in work-related RA. These findings add to a growing body of literature on increased risk of RA associated not only with silica but other exposures as well, across a range of vocational factors 20–27. In arthritis in general, but especially in RA, clinicians should consider occupational histories in the aetiology of disease, in both current and retired workers.…”

The role of environmental exposures and gene–environment interactions in the etiology of systemic lupus erythematous

“…Adverse respiratory effects from deployed military base burn pits (devoted to open-air combustion of waste) are well documented, although no clear link with SLE was seen after up to 2.8 years of follow-up in a large US cohort, possibly due to power issues (the average follow-up was only 1.3 years) or outcome ascertainment error (since SLE was identified on the basis of electronic medical records and not otherwise clinically confirmed) [68,69]. Another recent study using a military job exposure matrix surprisingly reported an inverse association with inorganic dust exposure and SLE risk among veterans receiving care through the US Veteran's Affairs medical system [70]. Evidence for other respiratory exposures, such as organic dusts (i.e., molds, pollens, animal matter, grains, plant fibers, etc.)…”

Occupational Exposures in Rheumatoid Arthritis-related Airway Disease: A Missing Link?

“…2 Military inorganic dust exposure has also been associated with the development of RA compared to other occupations within the armed forces. 3 Prolonged exposure to the World Trade Center disaster site has also been associated with an increased rate of autoimmune disease, the most prevalent of which was RA. 4 Other occupations have demonstrated gender-specific associations with RA: bricklayers and concrete workers have an increased risk of RA among men, while nurses and Copyright © 2022 by the American Thoracic Society medical attendants have increased risk among women.…”

“…One telephone survey in an area with high mortality from coal workers’ pneumoconiosis found that residents with a history of coal mining exposure had more than threefold odds of reporting a diagnosis of RA, leading to a population attributable fraction of 33% of those studied ( 2 ). Military inorganic dust exposure has also been associated with the development of RA compared with other occupations within the armed forces ( 3 ). Prolonged exposure to the World Trade Center disaster site has also been associated with an increased rate of autoimmune disease, the most prevalent of which was RA ( 4 ).…”