Pathological Studies of Modified Pneumoconiosis in Coal-miners with Rheumatoid Arthritis (Caplan's Syndrome)

Gough, J.; Rivers, Desiree; Seal, R. M. E.

doi:10.1136/thx.10.1.9

Cited by 108 publications

(25 citation statements)

References 7 publications

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“…Rheumatoid Pneumoconiosis (Caplan Syndrome) In coal miners with circulating rheumatoid factor, rheumatoid pneumoconiosis (Caplan syndrome) can occur (54,55). It is reported to be more common in Europe, particularly in Welsh miners.…”

Section: Coal Workers' Pneumoconiosismentioning

confidence: 99%

Silicosis and coal workers' pneumoconiosis.

Castranova

Vallyathan

2000

Environ Health Perspect

305

176

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Exposure to coal mine dust and/or crystalline silica results in pneumoconiosis with initiation and progression of pulmonary fibrosis. This review presents characteristics of simple and complicated coal workers' pneumoconiosis (CWP) as well as pathologic indices of acute and chronic silicosis by summarizing results of in vitro, animal, and human investigations. These results support four basic mechanisms in the etiology of CWP and silicosis: a) direct cytotoxicity of coal dust or silica, resulting in lung cell damage, release of lipases and proteases, and eventual lung scarring; b) activation of oxidant production by pulmonary phagocytes, which overwhelms the antioxidant defenses and leads to lipid peroxidation, protein nitrosation, cell injury, and lung scarring; c) activation of mediator release from alveolar macrophages and epithelial cells, which leads to recruitment of polymorphonuclear leukocytes and macrophages, resulting in the production of proinflammatory cytokines and reactive species and in further lung injury and scarring; o) secretion of growth factors from alveolar macrophages and epithelial cells, stimulating fibroblast proliferation and eventual scarring. Results of in vitro and animal studies provide a basis for proposing these mechanisms for the initiation and progression of pneumoconiosis. Data obtained from exposed workers lend support to these mechanisms.

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Section: Coal Workers' Pneumoconiosismentioning

confidence: 99%

Silicosis and coal workers' pneumoconiosis.

Castranova

Vallyathan

2000

Environ Health Perspect

305

176

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“…Caplan's recognition of the eponymous syndrome (45) gave impetus to implication of the immune system in the coniotic response. Epidemiological studies established the association between rheumatoid arthritis and a special form of radiological appearance in the lungs of coal workers (46), rheumatoid and orthodox pneumoconiosis being distinguished pathologically (47). The serum titer of rheumatoid factor (RF) was highest in Caplan's syndrome and some cases of PMF, in which lesions the factor was frequently localized by immunohistology (48).…”

Section: Human Responsesmentioning

confidence: 99%

Prevalence and pathogenesis of pneumoconiosis in coal workers.

Heppleston

1988

Environ Health Perspect

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Dust dose and composition do not appear to account wholly for changes in the prevalence of coal workers' pneumoconiosis in Europe. In certain coal pits high progression evidently occurred with relatively low dust exposure or vice versa, whereas progression in relation to dust levels might be variable. Exceptionally high quartz concentrations occur in coal mine dust when pneumoconiosis may progress with unusual rapidity. Under such circumstances lesions resembling silicotic nodules may be found, but with the customarily lower levels of quartz the pathological features assume the form characteristic of coal workers. Morphological changes in relation to dust content of human and animal lungs, as well as cellular behavior, have not accounted completely for the epidemiological findings. Considering all the pathological evidence helps explain the pathogenesis of pneumoconiosis and vagaries of progression. The origin of progressive massive fibrosis cannot be explained simply in terms of dust burden or immunological features, and the role of an infective factor cannot be dismissed. Moreover, lipid secretion by alveolar epithelium introduces a new element that could affect the development of simple and complicated pneumoconiosis. In vitro, cytotoxicity appeared to be too variable for predictive purposes, though direct assay of fibrogenicity using the macrophage fibrogenic factor suggested that dust dose was more important than dust composition. Assessing individual susceptibility presents serious obstacles.

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“…A lung biopsy showed nonspecific fibrosis without silicotic or rheumatoid order to diagnose rheumatoid pneumoconiosis, regardless of the presence of nodules characteristic of pneumoconiosis. Perhaps the most sensible view regarding nomenclature and classification of this entity was that put forth by Honma and Vallyathan, (2) who classified rheumatoid pneumoconiosis as two types: classic (Caplan's syndrome), as described by Caplan in 1953Caplan in /1959 (1,9) and by Gough in 1955 (8) ; and silicotic, without rheumatoid nodules in the lungs, although with small silicotic nodules, or pneumoconiosis as a consequence of mixed dust, accompanied by RA.…”

Section: Case Reportmentioning

confidence: 99%

“…(5) Studies in the French literature have proposed that this syndrome be called Colinet-Caplan's syndrome, due to the description of cases with the clinical and radiological characteristics described by Caplan in three patients with silicosis and RA, diagnosed in 1948 and 1950. (6,7) In 1955, Gough (8) described the histopathological alterations of the syndrome, showing that the nodules described by Caplan in simple X-rays were rheumatoid nodules, with central area of necrotic collagen, surrounded by an inflammatory process involving macrophages and leucocytes, with varying degrees of dust deposition. In 1992, Gardner corroborated Gough's findings, stating that the presence of a rheumatoid nodule in the lung was necessary in ical profile that was different from the images typically seen in coal miners with CWP.…”

Section: Case Reportmentioning

confidence: 99%

Pneumoconiose reumatoide (síndrome de Caplan) com apresentação clássica

et al. 2009

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Although rare, rheumatoid pneumoconiosis, also known as Caplan's syndrome, can occur in workers exposed to silica, as well as in patients with silicosis, coal workers' pneumoconiosis or asbestosis. Prevalence is higher among patients with silicosis, despite the fact that it was originally described in coal workers with pneumoconiosis. The classical finding that defines this syndrome is that of rheumatoid nodules in the lungs, regardless of whether there are small rounded opacities suggestive of pneumoconiosis or large opacities consistent with massive pulmonary fibrosis, with or without clinical rheumatoid arthritis. We describe the case of a female patient with rheumatoid arthritis, diagnosed 34 years after 7 years of occupational exposure to silica at a porcelain plant. A chest X-ray showed circular opacities of 1-5 cm in diameter, bilaterally distributed at the periphery of the lungs. A CT-guided thoracic punch biopsy of one of those nodules revealed that it was rheumatoid nodule surrounded by a palisade of macrophages, which is typical of Caplan's syndrome. Aspects of diagnosis, classification and occurrence of this syndrome are discussed, emphasizing the importance of the occupational anamnesis of patients with rheumatoid arthritis and lung opacities on chest X-rays.Keywords: Pneumoconiosis; Arthritis, rheumatoid; Caplan's syndrome; Silicosis. ResumoApesar de rara, a pneumoconiose reumatoide, também chamada de síndrome de Caplan, pode ser diagnosticada entre trabalhadores expostos à sílica e entre pacientes com silicose, pneumoconiose dos mineiros de carvão e asbestose. A maior prevalência ocorre entre os silicóticos, apesar de ter sido descrita inicialmente em mineiros de carvão com pneumoconiose. O achado que define o tipo clássico da síndrome é a presença de nódulos reumatoides nos pulmões, independente da presença ou não de pequenas opacidades pneumoconióticas, ou de grandes opacidades de fibrose pulmonar maciça, associada ou não a um quadro de artrite reumatoide em atividade. Relatamos o caso de uma mulher com quadro de artrite reumatoide, diagnosticada 34 anos após exposição à sílica livre em uma indústria de porcelana por 7 anos, apresentando radiograma de tórax com opacidades arredondadas de 1 a 5 cm de diâmetro, distribuídas na periferia de ambos os pulmões. A biópsia transtorácica guiada por TC de um dos nódulos revelou tratar-se de nódulo reumatoide com macrófagos em paliçada, típico da síndrome de Caplan. São discutidos aspectos de diagnóstico da síndrome, classificação e ocorrência, ressaltando a importância da anamnese ocupacional em casos de artrite reumatoide com opacidades radiológicas pulmonares.

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Pathological Studies of Modified Pneumoconiosis in Coal-miners with Rheumatoid Arthritis (Caplan's Syndrome)

Cited by 108 publications

References 7 publications

Silicosis and coal workers' pneumoconiosis.

Silicosis and coal workers' pneumoconiosis.

Prevalence and pathogenesis of pneumoconiosis in coal workers.

Pneumoconiose reumatoide (síndrome de Caplan) com apresentação clássica

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