title: Autoimmune/inflammatory syndrome (ASIA) induced by biomaterials injection other than silicone medical grade.
abstract: BACKGROUND
  Systemic autoimmune/granulomatous adverse reactions related to biomaterials other than silicone have rarely been reported.
  
  
  OBJECTIVE
  The aim of this paper is to communicate the cases of autoimmune/inflammatory syndrome induced by adjuvants (ASIA) in a study of Spanish patients suffering from inflammatory disorders related to biomaterial injections other than silicone, principally hyaluronic acid, acrylamides or methacrylate compounds.
  
  
  METHODS
  The authors performed a retrospective analysis of the clinical, laboratory, histopathology and follow-up of a cohort of 250 cases of patients suffering from inflammatory/autoimmune disorders related to bioimplant injections.
  
  
  RESULTS
  Of these 250 cases, patients with adverse reactions related to silicone injections (n = 65) were excluded. Of the remaining 185, 15 cases (8%) had systemic or distant and multiple complaints that could be categorized as ASIA. In all but four patients, inflammatory features at the implantation site preceded distant or systemic manifestations. Abnormal blood tests were common. Eleven cases (73.3%) with inflammatory localized nodules and panniculitis evolved into a variety of disorders, namely, primary biliary cirrhosis, Sjögren's syndrome, sarcoidosis, human adjuvant disease and inflammatory polyradiculopathy. Four cases presented primarily with systemic autoimmune disorders.
  
  
  CONCLUSIONS
  Infrequently, biomaterials other than silicone can provoke local inflammatory adverse reactions that may evolve into systemic autoimmune and/or granulomatous disorders. Whether or not these biomaterials act as an adjuvant, they could be included in the ASIA category.
authors.affiliation: Ageing Research and Systemic Autoimmune Disease Unit, Department of Internal Medicine I, Vall d'Hebron University Hospital, Spain. jalijota@vhebron.net
authors.forename: J
authors.initials: J
authors.lastname: Alijotas-Reig
authors.forename: V
authors.initials: V
authors.lastname: Garcia-Gimenez
authors.forename: E
authors.initials: E
authors.lastname: Llurba
authors.forename: M
authors.initials: M
authors.lastname: Vilardell-Tarrés
mesh_terms: D000178:Acrylamides / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology; D001327:Autoimmune Diseases / Q000139:chemically induced* / Q000276:immunology / Q000503:physiopathology; D001672:Biocompatible Materials / Q000008:administration & dosage / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage / Q000009:adverse effects / Q000276:immunology; D007249:Inflammation / Q000139:chemically induced* / Q000276:immunology / Q000503:physiopathology; D007267:Injections; D008297:Male; D008689:Methacrylates / Q000008:administration & dosage / Q000009:adverse effects; D019736:Prostheses and Implants / Q000009:adverse effects; D012189:Retrospective Studies; D013030:Spain; D013577:Syndrome
chemical_list: D000178:Acrylamides; D001672:Biocompatible Materials; D008689:Methacrylates; D006820:Hyaluronic Acid