Connective Tissue Disease in People Exposed to Organic Chemical Solvents: Systemic Sclerosis (Scleroderma) in Dry Cleaning Plant and Aircraft Industry Workers

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The etiology of connective tissue disease appears to be multifactorial and includes genetic factors, autoimmune responsiveness and environmental elements. This survery in a clinical rheumatology practice has investigated the relationship of environmental occupational organic solvent exposure and the presence of connective tissue disease. Two hundred and seventynine consecutive patients with various connective tissue diseases were classified according to the American College of Rheumatology criteria for systemic lupus erythematosus, systemic sclerosis (scleroderma), and rheumatoid arthritis and clinically as dermatomyositis/polymyositis, mixed connective tissue disease, and Sjogren's syndrome. Comprehensive questionnaires were used regarding diagnosis, occupational history and chemical and other substance exposure.

There was a striking increase in exposure to organic chemical solvents in the population of people with systemic sclerosis. Twelve of 33 people with scleroderma gave a history of organic chemical exposure versus 22 of the other 246 people (p = .00001); 3 of 33 with systemic sclerosis were exposed to perchloroethylene versus 2 of the other 246 (p = .00076), 2 scleroderma patients to trichloroethane versus 1 of the other 246 (p = .0031), and 2 scleroderma patients each to petroleum solvent and fluorocarbon solvent versus 0 of the other 246 (p = .00011) for each. Four of these 33 scleroderma patients worked in dry cleaning plants versus one of the other 246 (p < .00001), and 2 scleroderma subjects had been cleaning airplane parts versus 2 of the other 246 (p = .00076).

These observations support a hypothesis for a role of occupational exposure in some patients with scleroderma. Prospective epidemiologic studies are needed. Clinicians should question new patients about such exposures and may wish to counsel them about avoiding exposures. However, no data have yet suggested that stopping the exposures made patients healthier.

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