title: Occupational and environmental scleroderma. Systematic review and meta-analysis.
abstract: The etiology of systemic sclerosis (SSc) remains unknown; however, several occupational and environmental factors have been implicated. Our objective was to perform a meta-analysis of all studies published on SSc associated with occupational and environmental exposure. The review was undertaken by means of MEDLINE and SCOPUS from 1960 to 2014 and using the terms: "systemic," "scleroderma," or "systemic sclerosis/chemically induced" [MesH]. The Newcastle-Ottawa Scale was used for the qualifying assessment. The inverse variance-weighted method was performed. The meta-analysis of silica exposure included 15 case-control studies [overall OR 2.81 (95%CI 1.86-4.23; p < 0.001)] and 4 cohort studies [overall RR 17.52 (95%CI 5.98-51.37; p < 0.001)]; the meta-analysis of solvents exposure included 13 case-control studies (overall OR 2.00 [95%CI 1.32-3.02; p = 0.001); the meta-analysis of breast implants exposure included 4 case-control studies (overall OR 1.68 (95%CI 1.65-1.71; p < 0.001)) and 6 cohort studies (overall RR 2.13 (95%CI 0.86-5.27; p = 0.10)); the meta-analysis of epoxy resins exposure included 4 case-control studies (overall OR 2.97 (95%CI 2.31-3.83; p < 0.001)), the meta-analysis of pesticides exposure included 3 case-control studies (overall OR 1.02 (95%CI 0.78-1.32; p = 0.90)) and, finally, the meta-analysis of welding fumes exposure included 4 studies (overall OR 1.29 (95%CI 0.44-3.74; p = 0.64)). Not enough studies citing risks related to hair dyes have been published to perform an accurate meta-analysis. Silica and solvents were the two most likely substances related to the pathogenesis of SSc. While silica is involved in particular jobs, solvents are widespread and more people are at risk of having incidental contact with them.
authors.affiliation: Autoimmune Diseases Unit. Department of Internal Medicine, Bellvitge University Hospital-IDIBELL. L'Hospitalet de Llobregat, Feixa Llarga s/n, Hospitalet de Llobregat, Barcelona, Spain. mrubio@bellvitgehospital.cat.
authors.forename: Manuel
authors.initials: M
authors.lastname: Rubio-Rivas
authors.affiliation: Autoimmune Diseases Unit. Department of Internal Medicine, Bellvitge University Hospital-IDIBELL. L'Hospitalet de Llobregat, Feixa Llarga s/n, Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Moreno
authors.affiliation: Autoimmune Diseases Unit. Department of Internal Medicine, Bellvitge University Hospital-IDIBELL. L'Hospitalet de Llobregat, Feixa Llarga s/n, Hospitalet de Llobregat, Barcelona, Spain.|Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Corbella
mesh_terms: D018427:Breast Implants / Q000009:adverse effects*; D016022:Case-Control Studies; D004781:Environmental Exposure / Q000009:adverse effects*; D006801:Humans; D016273:Occupational Exposure / Q000009:adverse effects*; D010575:Pesticides / Q000633:toxicity*; D012595:Scleroderma, Systemic / Q000209:etiology*; D012822:Silicon Dioxide / Q000633:toxicity*; D012997:Solvents / Q000633:toxicity*
chemical_list: D010575:Pesticides; D012997:Solvents; D012822:Silicon Dioxide
keywords: Environment; Occupational exposure; Systemic sclerosis