title: Clinical peculiarities of patients with scleroderma exposed to silica: A systematic review of the literature.
abstract: OBJECTIVE
  There are few data regarding the existence of clinical differences between patients with systemic sclerosis (scleroderma) exposed to silica (SSc-si) and "idiopathic" cases (SSc-id). Our goal is to describe the clinical characteristics of patients with SSc-si and see if they differ from the SSc-id cases.
  
  
  METHODS
  We performed a systematic review of the literature by searching the MEDLINE, EMBASE and Web of Science databases. We also included our own series of patients diagnosed with SSc-si and SSc-id controls at the "Complejo Hospitalario Universitario de Vigo (CHUVI)" from 1985 to January 2013.
  
  
  RESULTS
  The review of the literature disclosed 32 published series, with clinical data of 254 SSc-si patients (96% males). SSc-si represented 37.5-86% of the scleroderma males and 0-2.7% of the scleroderma females. Globally, more than expected proportion of diffuse forms (61%) and interstitial lung disease (81%) were observed in exposed patients. In the present series, the diagnosis of SSc exposure to silica was recorded in nine patients (9.5%), showing predominance of the diffuse form (77%, p = 0.001), positivity for anti-Scl70 (55%, p = 0.001), presence of ILD (78%, p = 0.048) and lower survival (9.2 versus 15.1, p = 0.023). Diffuse variant remained more prevalent analysing exposed versus non-exposed women (50% versus 8%, p = 0,000) and exposed versus non-exposed men (85.8% versus 50%, p = 0,000).
  
  
  CONCLUSIONS
  Silica exposure is a predominant risk factor in male SSc populations. The review of the literature is consistent with an association of SSc-si and diffuse scleroderma. A trend toward lower survival was observed in our series in SSc-si group.
authors.affiliation: Thrombosis and Vasculitis Unit, Complexo Hospitalario Universitario de Vigo (CHUVI), Planta 11, c/Pizarro 22, Vigo 36204, Spain. Electronic address: Maria.carmen.freire.dapena@sergas.es.
authors.forename: Mayka
authors.initials: M
authors.lastname: Freire
authors.affiliation: Thrombosis and Vasculitis Unit, Complexo Hospitalario Universitario de Vigo (CHUVI), Planta 11, c/Pizarro 22, Vigo 36204, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Alonso
authors.affiliation: Thrombosis and Vasculitis Unit, Complexo Hospitalario Universitario de Vigo (CHUVI), Planta 11, c/Pizarro 22, Vigo 36204, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Rivera
authors.affiliation: Thrombosis and Vasculitis Unit, Complexo Hospitalario Universitario de Vigo (CHUVI), Planta 11, c/Pizarro 22, Vigo 36204, Spain.
authors.forename: Adrián
authors.initials: A
authors.lastname: Sousa
authors.affiliation: Thrombosis and Vasculitis Unit, Complexo Hospitalario Universitario de Vigo (CHUVI), Planta 11, c/Pizarro 22, Vigo 36204, Spain.
authors.forename: Adriana
authors.initials: A
authors.lastname: Soto
authors.affiliation: Thrombosis and Vasculitis Unit, Complexo Hospitalario Universitario de Vigo (CHUVI), Planta 11, c/Pizarro 22, Vigo 36204, Spain.
authors.forename: Jose Manuel
authors.initials: JM
authors.lastname: Gómez-Sousa
authors.affiliation: Thrombosis and Vasculitis Unit, Complexo Hospitalario Universitario de Vigo (CHUVI), Planta 11, c/Pizarro 22, Vigo 36204, Spain.
authors.forename: Aida
authors.initials: A
authors.lastname: Baroja
authors.affiliation: Thrombosis and Vasculitis Unit, Complexo Hospitalario Universitario de Vigo (CHUVI), Planta 11, c/Pizarro 22, Vigo 36204, Spain.
authors.forename: Caritina
authors.initials: C
authors.lastname: Vázquez-Triñanes
authors.affiliation: Thrombosis and Vasculitis Unit, Complexo Hospitalario Universitario de Santiago (CHUS), Universidad de Santiago de Compostela, Santiago de Compostela, Spain.
authors.forename: Bernardo
authors.initials: B
authors.lastname: Sopeña
mesh_terms: D005260:Female; D006801:Humans; D017563:Lung Diseases, Interstitial / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D016273:Occupational Exposure; D015995:Prevalence; D012307:Risk Factors; D012595:Scleroderma, Systemic / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D012822:Silicon Dioxide / Q000633:toxicity*
chemical_list: D012822:Silicon Dioxide
keywords: ASIA; Autoimmune/inflammatory syndrome induced by adjuvants; Epidemiology; Occupational disease; Scleroderma; Silica; Systematic review; Systemic sclerosis