title: Association of occupational exposure with features of systemic sclerosis.
abstract: BACKGROUND
  Occupational exposure is reported as playing a substantial causative role in systemic sclerosis (SSc).
  
  
  OBJECTIVE
  We sought to compare the characteristics of SSc in patients with and without occupational exposure to crystalline silica/solvents.
  
  
  METHODS
  In all, 142 patients with SSc were enrolled in this prospective study. An expert committee performed blind evaluation of occupational exposure to crystalline silica/solvents.
  
  
  RESULTS
  Patients exposed to crystalline silica more often exhibited: diffuse cutaneous SSc (P = .02), digital ulcers (P = .05), interstitial lung disease (P = .0004), myocardial dysfunction (P = .006), and cancer (P = .06). Patients exposed to solvents more frequently developed: diffuse cutaneous SSc (P = .001), digital ulcers (P = .01), interstitial lung disease (P = .02), myocardial dysfunction (P = .04), and cancer (P = .003); in addition, these patients were more frequently anti-Scl 70 positive and anticentromere negative. Under multivariate analysis, significant factors for SSc associated with exposure to silica/solvents were: male gender (odds ratio 19.31, 95% confidence interval 15.34-69.86), cancer (odds ratio 5.97, 95% confidence interval 1.55-23.01), and digital ulcers (odds ratio 2.42, 95% confidence interval 1.05-5.56).
  
  
  CONCLUSIONS
  The cohort originated from a single geographic region.
  
  
  CONCLUSIONS
  Occupational exposure to crystalline silica/solvents is correlated with more severe forms of SSc characterized by: diffuse cutaneous involvement, interstitial lung disease, general microangiopathy (digital ulcers and myocardial dysfunction), and association with cancer. Occupational exposure should be systematically checked in all patients with SSc, as exposed patients seem to develop more severe forms of SSc.
authors.affiliation: Department of Internal Medicine, Centre Hospitalier Universitaire (CHU) Rouen, and Institut National de la Santé et de la Recherche Biomédicale (INSERM) Unit 905, University of Rouen Institut Fédératif Multidisciplinaire sur les Peptides (IFRMP), Institute for Biochemical Research, Rouen, France. Electronic address: isabelle.marie@chu-rouen.fr.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Marie
authors.affiliation: Department of Biostatistics, CHU Rouen, Rouen, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Menard
authors.affiliation: Department of Dermatology, CHU Rouen, Rouen, France.
authors.forename: Anne-Bénédicte
authors.initials: AB
authors.lastname: Duval-Modeste
authors.affiliation: Department of Dermatology, CHU Rouen, Rouen, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Joly
authors.affiliation: Department of Pneumology, CHU Rouen, Rouen, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Dominique
authors.affiliation: Department of Dermatology, CHG Le Havre, Le Havre, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Bravard
authors.affiliation: Department of Internal Medicine, Centre Hospitalier Général (CHG) Elbeuf, Elbeuf, France.
authors.forename: David
authors.initials: D
authors.lastname: Noël
authors.affiliation: Department of Occupational Medicine, CHU Rouen, Rouen, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Gehanno
authors.affiliation: Department of Epidemiology, CHU Rouen, Rouen, France.
authors.forename: Michael
authors.initials: M
authors.lastname: Bubenheim
authors.affiliation: Department of Epidemiology, CHU Rouen, Rouen, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Benichou
authors.affiliation: Department of Internal Medicine, Centre Hospitalier Universitaire (CHU) Rouen, and Institut National de la Santé et de la Recherche Biomédicale (INSERM) Unit 905, University of Rouen Institut Fédératif Multidisciplinaire sur les Peptides (IFRMP), Institute for Biochemical Research, Rouen, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Levesque
mesh_terms: D000328:Adult; D000368:Aged; D009783:Dermatitis, Occupational / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects*; D011446:Prospective Studies; D045743:Scleroderma, Diffuse / Q000139:chemically induced; D012595:Scleroderma, Systemic / Q000139:chemically induced* / Q000175:diagnosis; D012822:Silicon Dioxide / Q000009:adverse effects*; D012997:Solvents / Q000009:adverse effects*
chemical_list: D012997:Solvents; D012822:Silicon Dioxide
keywords: cancer; crystalline silica; digital ulcers; interstitial lung disease; occupational factors; solvents; systemic sclerosis