title: Systemic sclerosis and exposure to heavy metals: A case control study of 100 patients and 300 controls.
abstract: OBJECTIVE
  This case control study assessed: 1) the relationship of systemic sclerosis (SSc) related to exposure to heavy metals; and 2) the risk of SSc related to occupational exposure in male and female patients.
  
  
  METHODS
  From 2005 to 2008, 100 patients with a definite diagnosis of SSc were included in the study; 3 age, gender, and smoking habit matched controls were selected for each patient. All SSc patients and controls underwent detection and quantification of heavy metal traces in hair samples, using multi-element inductively coupled plasma mass spectrometry (ICP-MS).
  
  
  RESULTS
  SSc patients exhibited higher median levels of the following metals: antimony (p=0.001), cadmium (p=0.0003), lead (p=0.02), mercury (p=0.02), molybdenum (p=0.04), palladium (p<0.0001) and zinc (p=0.0003). A marked association between SSc and occupational exposure was further found for: 1) antimony (p=0.008) and platinum (p=0.04) in male patients; and 2) antimony (p=0.02), cadmium (p=0.001), lead (p=0.03), mercury (p=0.03), palladium (p=0.0003) and zinc (p=0.0001) in female patients CONCLUSION: The results show the impact of occupational risk factors in the development of SSc for: antimony, cadmium, lead, mercury, molybdenum, palladium and zinc. Thus, occupational exposure should be systematically checked in all SSc patients at diagnosis. Finally, the association between SSc and occupational exposure may be variable according to patients' gender.
authors.affiliation: Department of Internal Medicine, CHU Rouen, and INSERM U 905, University of Rouen IFRMP, Institute for Biochemical Research, F-76000 Rouen, France. Electronic address: isabelle.marie@chu-rouen.fr.
authors.forename: I
authors.initials: I
authors.lastname: Marie
authors.affiliation: Department of Occupational Medicine, CHU Rouen, Rouen, France.
authors.forename: J-F
authors.initials: JF
authors.lastname: Gehanno
authors.affiliation: Department of Biostatistics, CHU Rouen, Rouen, France.
authors.forename: M
authors.initials: M
authors.lastname: Bubenheim
authors.affiliation: Department of Dermatology, CHU Rouen, Rouen, France.
authors.forename: A-B
authors.initials: AB
authors.lastname: Duval-Modeste
authors.affiliation: Department of Dermatology, CHU Rouen, Rouen, France.
authors.forename: P
authors.initials: P
authors.lastname: Joly
authors.affiliation: Department of Pneumology, CHU Rouen, Rouen, France.
authors.forename: S
authors.initials: S
authors.lastname: Dominique
authors.affiliation: Department of Dermatology, CHG Le Havre, Le Havre, France.
authors.forename: P
authors.initials: P
authors.lastname: Bravard
authors.affiliation: Department of Internal Medicine, CHG Elbeuf, Elbeuf, France.
authors.forename: D
authors.initials: D
authors.lastname: Noël
authors.affiliation: Clinical Investigation Center, CIC 0204-INSERM, Institute for Biomedical Research, CHU Rouen, Rouen, France.
authors.forename: A-F
authors.initials: AF
authors.lastname: Cailleux
authors.affiliation: Department of Epidemiology, CHU Rouen, Rouen, France.
authors.forename: J
authors.initials: J
authors.lastname: Benichou
authors.affiliation: Department of Internal Medicine, CHU Rouen, and INSERM U 905, University of Rouen IFRMP, Institute for Biochemical Research, F-76000 Rouen, France.
authors.forename: H
authors.initials: H
authors.lastname: Levesque
authors.affiliation: Laboratory of Toxicology, CHG Le Havre, Le Havre, France.
authors.forename: J-P
authors.initials: JP
authors.lastname: Goullé
mesh_terms: D016022:Case-Control Studies; D004781:Environmental Exposure / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D019216:Metals, Heavy / Q000009:adverse effects*; D016273:Occupational Exposure / Q000009:adverse effects*; D012307:Risk Factors; D012595:Scleroderma, Systemic / Q000209:etiology*
chemical_list: D019216:Metals, Heavy
keywords: Crystalline silica; Environmental factors; Heavy metals; Occupational factors; Solvents; Systemic sclerosis