Occupational Exposure to Silica and Autoimmune Diseases: A Systematic Review

Abstract

Since the first report about the association between occupational exposure to silica and autoimmune diseases more than a century ago, the hypothesis has generated numerous publications but no conclusive statements. This systematic review retrieved 82 epidemiological studies, including cross-sectional, longitudinal, and case-control studies, and 19 studies addressing the possible mechanisms. Major drawbacks include poor assessment of silica exposure, the retrospective nature, the poor quality of a large part of these studies, their limited number for some autoimmune diseases, and the frequent lack of consideration of possible occupational confounders. Nonetheless, the results confirm sufficient evidence for an association between long-term, high-level exposure to silica and the risk of rheumatoid arthritis, scleroderma, and systemic lupus erythematosus, and insufficient evidence for dermatomyositis, Sjögren syndrome, ANCA-positive vasculitis, including Wegener’s granulomatosis, and sarcoidosis. The potential mechanisms of such associations are discussed.

Keywords

silica / silicosis / rheumatoid arthritis / scleroderma / systemic lupus erythematosus / dermatomyositis / sjögren syndrome / vasculitis

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