title: Outbreak of autoimmune disease in silicosis linked to artificial stone.
abstract: BACKGROUND
  There is a well-established association between inhalational exposure to silica and autoimmune disease. We recently observed an outbreak of silica-related autoimmune disease among synthetic stone construction workers with silicosis referred for lung transplantation assessment.
  
  
  OBJECTIVE
  To characterize the rheumatologic complications in silicosis within these highly exposed, clinically well-characterized patients.
  
  
  METHODS
  We systematically reviewed data from all cases of silicosis due to synthetic stone dust referred to our pulmonary institute for lung transplant assessment, which represents the national centre for all such referrals. In addition to silicosis-specific data, we extracted data relevant to the clinical and serological manifestations of autoimmune diseases present in these patients.
  
  
  RESULTS
  Of 40 patients in our advanced silicosis national data, we identified nine (23%) with findings consistent with various autoimmune diseases. Among these nine, three also had findings consistent with pulmonary alveolar proteinosis. Based on an expected autoimmune disease prevalence of 3% (based on the upper-end estimate for this group of diseases in European international data), the proportion of disease in our group represents a >7-fold excess (prevalence ratio 7.5; 99% confidence interval 2.6-16.7).
  
  
  CONCLUSIONS
  These cases underscore the strong link between silicosis and multiple distinct syndromes of autoimmune diseases. Vigilance is warranted for the recognition of autoimmune complications in persons with known silicosis; so too is consideration of the occupational exposure history in persons presenting with manifestations of autoimmune disease.
authors.affiliation: Pulmonary Institute, Rabin Medical Centre, Beilinson Campus, Petah Tikva 49100, Israel, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: O
authors.initials: O
authors.lastname: Shtraichman
authors.affiliation: Division of Occupational and Environmental Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA 94143-0924, USA.
authors.forename: P D
authors.initials: PD
authors.lastname: Blanc
authors.affiliation: Pulmonary Institute, Rabin Medical Centre, Beilinson Campus, Petah Tikva 49100, Israel, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: J E
authors.initials: JE
authors.lastname: Ollech
authors.affiliation: Pathology Institute, Rabin Medical Centre, Beilinson Campus, Petah Tikva 49100, Israel, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: L
authors.initials: L
authors.lastname: Fridel
authors.affiliation: Pulmonary Institute, Rabin Medical Centre, Beilinson Campus, Petah Tikva 49100, Israel, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: L
authors.initials: L
authors.lastname: Fuks
authors.affiliation: Institute of Pulmonary and Allergic Diseases, National Service for Interstitial Lung Diseases, Tel Aviv Sourasky Medical Centre, Tel Aviv 6423906, Israel.
authors.forename: E
authors.initials: E
authors.lastname: Fireman
authors.affiliation: Pulmonary Institute, Rabin Medical Centre, Beilinson Campus, Petah Tikva 49100, Israel, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, kremerm@clalit.org.il.
authors.forename: M R
authors.initials: MR
authors.lastname: Kramer
mesh_terms: D000328:Adult; D015551:Autoimmunity; D003252:Construction Materials / Q000009:adverse effects*; D004196:Disease Outbreaks; D004391:Dust; D005260:Female; D006801:Humans; D019570:Inhalation Exposure / Q000009:adverse effects*; D007557:Israel / Q000453:epidemiology; D016040:Lung Transplantation / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure / Q000009:adverse effects*; D015995:Prevalence; D012017:Referral and Consultation; D012216:Rheumatic Diseases / Q000453:epidemiology* / Q000209:etiology / Q000276:immunology; D012307:Risk Factors; D012822:Silicon Dioxide / Q000009:adverse effects*; D012829:Silicosis / Q000453:epidemiology* / Q000209:etiology / Q000276:immunology*; D013577:Syndrome
chemical_list: D004391:Dust; D012822:Silicon Dioxide
keywords: Autoimmune disease; pulmonary alveolar proteinosis; silicosis.