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- Volume 81,Issue 8
- Autoimmune diseases, autoantibody status and silicosis in a cohort of 1238 workers from the artificial stone benchtop industry
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Original research
Autoimmune diseases, autoantibody status and silicosis in a cohort of 1238 workers from the artificial stone benchtop industry
- http://orcid.org/0000-0003-2471-2523Dunya Tomic1,
- http://orcid.org/0000-0001-9150-9440Ryan F Hoy1,2,
- Jesselyn Sin1,
- Javier Jimenez Martin1,
- http://orcid.org/0000-0002-0295-4575Stella May Gwini1,
- Hayley Barnes1,2,
- Mandana Nikpour3,4,
- Kathleen Morrisroe3,4,
- Yuan Z Lim5,
- http://orcid.org/0000-0002-5992-1459Karen Walker-Bone1,6
- 1Centre for Occupational and Environmental Health, Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
- 2Department of Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia
- 3Department of Medicine, The University of Melbourne Medicine at St Vincent's Hospital, Fitzroy, Victoria, Australia
- 4Department of Rheumatology, St Vincent's Hospital Melbourne Pty Ltd, Fitzroy, Victoria, Australia
- 5Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
- 6MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton MRC Lifecourse Epidemiology Centre, Southampton, UK
- Correspondence to Dr Karen Walker-Bone, Monash Centre for Occupational and Environmental Health, Monash University School of Public Health and Preventive Medicine, Melbourne, VIC 3004, Australia; Karen.Walker-Bone{at}Monash.edu
Abstract
Objectives Autoimmune disorders are multifactorial but occupational exposures have long been implicated, including respirable crystalline silica (RCS). A modern epidemic of silicosis is emerging internationally, associated with dry processing of engineered stone with high (>90%) RCS content. We aimed to investigate the prevalence of clinical autoimmune disease and common autoantibodies in exposed workers.
Methods Stone benchtop industry workers in Victoria, Australia were offered free screening for silicosis and related disorders. Symptoms or diagnoses of autoimmune disease were evaluated by questionnaire and blood tests taken for rheumatoid factor (RF), antinuclear antibodies (ANAs) and extractable nuclear antigens (ENAs).
Results Among 1238 workers (93.3% male) screened from 2019 to 2021, 0.9% were confirmed with autoimmune disease. Among those without clinical disease, 24.6% had detectable ANAs (93.5% male), 4.6% detectable ENAs and 2.6% were positive for RF. Silicosis was diagnosed in 253 workers (24.3% of those with diagnostic information available). Of those with ANA readings, 54 (6.6%) had ANA titre >1:320. The likelihood of positive autoantibodies increased with age; smoking; higher exposure to RCS and silicosis diagnosis.
Conclusion The proportion of workers with detectable ANAs or ENAs was considerably higher than the 5%–9% expected in the general population. Some of the antibodies detected (eg, Scl-70, CENPB) have high sensitivity and specificity for systemic sclerosis. Long-term follow-up will be needed to estimate incidence. Rheumatologists should explore occupational history in new cases of autoimmune disease. Screening for autoimmune disease is indicated in workers exposed to RCS as these individuals need specialised management and may be entitled to compensation.
- Autoimmune Diseases
- Silicosis
Data availability statement
No data are available.
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- Autoimmune Diseases
- Silicosis
Data availability statement
No data are available.
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Footnotes
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Contributors DT is the content guarantor. DT had full access to all of the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis. RFH, JS, JJM, SMG, HB, MN, KM, YZL and KW-B contributed substantially to the study design, data analysis and interpretation, and the writing of the manuscript.
Funding This work was supported by WorkSafe Victoria.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.
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