Overlap syndrome with Sjögren’s syndrome and systemic sclerosis in a steel rolling mill worker: a case report
Tóm tắt
There are few reports about work-related factors associated with Sjögren’s syndrome. We report a case of overlap syndrome with Sjögren’s syndrome and systemic sclerosis. A 54-year-old man was admitted due to dyspnea on exertion. The results of physical examination and laboratory findings were compatible with Sjögren’s syndrome with systemic sclerosis. The patient had no pre-existing autoimmune disease, and denied family history of autoimmune disease. The patient worked in the large-scale rolling department of a steel manufacturing company for 25 years. Hot rolling is a rolling process performed at between 1100 °C and 1200 °C, generating a high temperature and a large amount of fumes, involving jet-spraying of water throughout the process to remove the instantaneously generated oxide film and prevent the high generation of fumes. In this process, workers could be exposed to silica produced by thermal oxidation. Other potential toxic substances including nickel and manganese seemed to be less likely associated with the patient’s clinical manifestations. Occupational exposure to silica seemed to be associated with the patient’s clinical manifestations of overlap syndrome with Sjögren’s syndrome and systemic sclerosis. Although the underlying mechanism is still unclear, autoimmune disease including Sjögren’s syndrome affects women more often than men and there was no family history of autoimmune disease. These suggested that there was an association between occupational silica exposure and the disease of the patient. Future research about the association between long-term low dose exposure to silica and the development of autoimmune diseases should be encouraged.
Tài liệu tham khảo
Maddison PJ. Mixed connective tissue disease, overlap syndrome, and eosinophilic fasciitis. Ann Rheum Dis. 1991;50:887–93.
Iaccarino L, Gatto M, Bettio S, Caso F, Rampudda M, Zen M, et al. Overlap connective tissue disease syndromes. Autoimmun Rev. 2013;12:363–73.
Fox RI. Sjögren syndrome. Lancet. 2005;366:321–31.
Morgan WS, Castleman B. A clinicopathologic study of Mikulicz’s disease. Am J Pathol. 1953;29:471–503.
Astudillo L, Sailler L, Ecoiffier M, Giron J, Couret B, Arlet-Suau E. Exposure to silica and primary Sjögren syndrome in a dental technician. Rheumatology. 2003;42:1269–70.
Groen H, Postma DS, Kallenberg CG. Interstitial lung disease and myositis in patient with simultaneously occurring sarcoidosis and scleroderma. Chest. 1993;104:1298–300.
Schachna L, Wigley FM. Targeting mediators of vascular injury in scleroderma. Curr Opin Rheumatol. 2002;14:686–93.
Vitali C, Bombardieri S, Jonsson R, Moutsopoulos HM, Alexander EL, Carsons SE, Daniels TE, Fox PC, Fox RI, Kassan SS, Pillemer SR, Talal N, Weisman MH, European Study Group on Classification Criteria for Sjögren’s Syndrome. Classification criteria for Sjögren’s syndrome: a revised version of the European criteria proposed by the American-European Consensus Group. Ann Rheum Dis. 2002;61:554–8.
van den Hoogen F, Khanna D, Fransen J, Johnson SR, Baron M, Tyndall A, et al. 2013 classification criteria for systemic sclerosis: an American College of Rheumatology/European League against Rheumatism collaborative initiative. Arthritis Rheum. 2013;65:2737–47.
Kim HD, Choi BJ, Kim SS, Kim CH, Oh YS. Material Properties of 400 MPa Grade Hot Rolled H-beam (SHN400) for Building Structure. J Korean Soc Steel Construction. 2011;23:515–22.
Caplan A. Certain radiological appearances in the chest of coal-miners suffering from rheumatoid arthritis. Thorax. 1953;8:29–37.
Klockars M, Koskela RS, Järvinen E, Kolari PJ, Rossi A. Silica exposure and rheumatoid arthritis: a follow up study of granite workers 1940–81. BMJ. 1987;294:997–1000.
Myong JP, Kim KY, Lim Y. A case of Caplan's syndrome with silicosis. Korean J Soc Occup Environ Med. 2008;20:160–4.
Cowie RL. Silica-dust-exposed mine workers with scleroderma (systemic sclerosis). Chest. 1987;92:260–2.
Miranda AAM, Nascimento AC, Peixoto IL, Scrignoli JA, Cardoso MSL, Ribeiro SLE. Erasmus syndrome: silicosis and systemic sclerosis. Rev Bras Reumatol. 2013;8:310–3.
Conrad K, Mehlhorn J, Luthke K, Dorner T, Frank K-H. Systemic lupus erythematosus after heavy exposure to quartz dust in uranium mines: clinical and serological characteristics. Lupus. 1996;5:62–9.
Yamazaki S, Yoshiike F, Hirai K, Kakegawa T, Ikeda M, Nagata A, et al. Silica-Associated Systemic Lupus Erythematosus in an Elderly Man. Intern Med. 2007;46:1867–71.
Sanchez-Roman J, Wichmann I, Salaberri J, Varela JM, Nunez-Roldan A. Multiple clinical and biological autoimmune manifestations in 50 workers after occupational exposure to silica. Ann Rheum Dis. 1993;52:534–8.
Puisieux F, Hachulla E, Brouillard M, Hatron PY, Devulder B. Silicosis and primary Gougerot-Sjögren syndrome. Rev Med Intern. 1994;15:575–9.
Ferreira PG, Ferreira AJ, Carvalho LM, Luis AS. Mixed pneumoconiosis due to silicates and hard metals associated with primary Sjögren’s syndrome due to silica. J Bras Pneumol. 2014;40:92–5.
Mossman BT, Churg A. Mechanisms in the pathogenesis of asbestosis and silicosis. Am J Respir Crit Care Med. 1998;157:1666–80.
Slavin RE, Swendo JL, Brandes D, Gonzalez-Vitale JC, Osomio-Vargas A. Extrapulmonary silicosis: a clinical, morphological and ultrastructural study. Hum Pathol. 1985;16:393–412.
Friedetzky A, Gam H, Kirchner A, Gemsa D. Histopathological change in enlarged thoracic lymph nodes during development of silicosis in rats. Immunobiology. 1998;199:119–32.
Davis GS, Pfeiffer LM, Hemenway DR. Persistent overexpression of interleukin-1beta and tumor necrosis factor-alpha in murine silicosis. J Environ Pathol Toxicol Oncol. 1998;17:99–114.
Driscoll KE, Carter JM, Hassenbein DG, Howard B. Cytokines and particle-induced inflammatory cell recruitment. Environ Health Perspect. 1997;105:1159–64.
Ueki A, Yamaguchi M, Ueki H, Watanabe Y, Ohsawa G, Kinugawa K, et al. Polyclonal human T-cell activation by silicate in vitro. Immunology. 1994;82:332–5.
Shoemaker DA, Pretty JR, Ramsey DM, McLaurin JL, Khan A, Teass AW, et al. Particle activity and in vivo pulmonary response to freshly milled and aged alpha-quartz. Scand J Work Envion Health. 1995;21:15–8.
Vallyathan V, Shi X, Castranova V. Reactive oxygen species: their relation to pneumoconiosis and carcinogenesis. Environ Health Perspect. 1998;106:1151–5.
Uber CL, McReynolds RA. Immunotoxicology of silica. Crit Rev Toxicol. 1982;10:303–19.
Deal BE, Grove AS. General Relationship for the Thermal Oxidation of Silicon. J App Physics. 1965;36:3770–8.
Davis GS, Leslie KO, Hemenway DR. Silicosis in mice: effects of dose, time, and genetic strain. J Environ Pathol Toxicol Oncol. 1998;17:81–97.
Levine S, Sowinski R. Enhancement of allergic encephalomyelitis by particulate adjuvants inoculated long before antigen. Am J Pathol. 1980;99:291–304.
Freitas M, Fernandes E. Zinc, cadmium and nickel increase the activation of NF-κB and the release of cytokines from THP-1 monocytic cells. Metallomics. 2011;3:1238–43.
Nemery B, Verbeken EK, Demedts M. Giant cell interstitial pneumonia (hard metal lung disease, cobalt lung). Semin Respir Crit Care Med. 2001;22:425–48.