Exploring lifetime occupational exposure and SLE flare: a patient-focussed pilot study.
BACKGROUND
Environmental effectors, such as ultraviolet radiation exposure, infection and stress, have been established as having a role in exacerbating lupus symptoms. However, unpredictable patterns of flare events still remain a mystery. Occupational effectors have also been suggested as having a contributing role; however, they are not widely researched. In this paper we report a pilot study designed to generate focus areas for future research regarding occupational exposures and systemic lupus erythematosus (SLE).


METHODS
The study explored potential links between exposures and the occurrence of patient-reported flare events in 80 Australian women with SLE (American College of Rheumatology (ACR) criteria classified). Specifically, the study assessed the hypothesis that occupational exposure is associated with significant changes in the likelihood of lupus flares. Lifetime employment history was analysed with the Finnish Job Exposure Matrix (FINJEM), 40 different semiquantified exposure class estimates for a wide number of occupations based on probability of exposure (p≥5%=exposed) were analysed with the construction of negative binomial regression models to test relationships between occupational agents and flare days. A backward stepwise elimination was used to generate a parsimonious model.


RESULTS
Significant associations were noted for exposure classes of manual handling burden, (p=0.02, incidence rate ratio (IRR) 1.01), Iron (p=0.00, IRR 1.37), wood dust (p=0.00, IRR 3.34) and asbestos (p=0.03, IRR 2.48).


CONCLUSIONS
Exposure assessment results indicated that occupations, such as nursing, with a high manual handling burden, posed increased risk to patients with SLE, however, the greatest risk was associated with wood dust and iron exposure with teachers and specialist labourers.
Faculty of Health and Medicine , University of Newcastle , Callaghan, New South Wales , Australia ; Faculty of Science and Information Technology , University of Newcastle , Callaghan, New South Wales , Australia ; Autoimmune Resource and Research Centre , New Lambton, New South Wales , Australia ; Hunter New England Health District , New Lambton, New South Wales , Australia ; Hunter Medical Research Institute , Newcastle, New South Wales , Australia.
Marline L
ML
Squance
Faculty of Health and Medicine , University of Newcastle , Callaghan, New South Wales , Australia ; Hunter Medical Research Institute , Newcastle, New South Wales , Australia.
Maya
M
Guest
Faculty of Health and Medicine , University of Newcastle , Callaghan, New South Wales , Australia ; Autoimmune Resource and Research Centre , New Lambton, New South Wales , Australia ; Hunter New England Health District , New Lambton, New South Wales , Australia ; Hunter Medical Research Institute , Newcastle, New South Wales , Australia.
Glenn
G
Reeves
Faculty of Health and Medicine , University of Newcastle , Callaghan, New South Wales , Australia ; Hunter New England Health District , New Lambton, New South Wales , Australia ; Hunter Medical Research Institute , Newcastle, New South Wales , Australia.
John
J
Attia
Faculty of Science and Information Technology , University of Newcastle , Callaghan, New South Wales , Australia.
Howard
H
Bridgman