Although the association between certain occupational exposures and the development of autoimmune rheumatic disease was first described over a century ago, this association has only become more widely recognized in the past 10 years because of the use of high-silica-content engineered stone in construction and home renovation. There is now a substantial and growing body of evidence that occupational dust and chemical exposure, be it through mining, stonemasonry, building or other trades, increases the risk of various systemic autoimmune rheumatic diseases (SARDs) including rheumatoid arthritis and systemic sclerosis. Although the pathogenic mechanisms of silica-induced autoimmunity are not fully elucidated, it is thought that alveolar macrophage ingestion of silica and the ensuing phagosomal damage is an initiating event that ultimately leads to production of autoantibodies and immune-mediated tissue injury. The purportedly causal association between occupational exposure to chemicals, such as organic solvents, and an increased risk of SARDs is less frequently recognized compared with silica dust, and its immunopathogenesis is less well understood. An appreciation of the importance of occupational dust and chemical exposures in the development of SARDs has implications for workplace health and safety regulations and offers a unique opportunity to better understand autoimmune disease pathogenesis and implement preventative strategies. This Review discusses the current evidence for the association between occupational exposures, particularly silica dust and solvents, and the risk of developing systemic autoimmune rheumatic diseases. The authors emphasize the importance of considering occupational history in the rheumatology clinic.

Paywall

Although the association between certain occupational exposures and the development of autoimmune rheumatic disease was first described over a century ago, this association has only become more widely recognized in the past 10 years because of the use of high-silica-content engineered stone in construction and home renovation.

There is now a substantial and growing body of evidence that occupational dust and chemical exposure, be it through mining, stonemasonry, building or other trades, increases the risk of various systemic autoimmune rheumatic diseases (SARDs) including rheumatoid arthritis and systemic sclerosis. Although the pathogenic mechanisms of silica-induced autoimmunity are not fully elucidated, it is thought that alveolar macrophage ingestion of silica and the ensuing phagosomal damage is an initiating event that ultimately leads to production of autoantibodies and immune-mediated tissue injury.

The purportedly causal association between occupational exposure to chemicals, such as organic solvents, and an increased risk of SARDs is less frequently recognized compared with silica dust, and its immunopathogenesis is less well understood.

An appreciation of the importance of occupational dust and chemical exposures in the development of SARDs has implications for workplace health and safety regulations and offers a unique opportunity to better understand autoimmune disease pathogenesis and implement preventative strategies.

Key points

  • Occupational exposure to silica dust is associated with several-fold increased risk of systemic sclerosis and also of developing rheumatoid arthritis, systemic lupus erythematosus, small-vessel vasculitis and sarcoidosis.

  • Occupational exposure to solvents is associated with an increased risk of systemic sclerosis and rheumatoid arthritis, and possibly other autoimmune diseases.

  • There are a large number of occupations ranging from construction and mining to petrochemical, plastics and rubber industries wherein potentially harmful exposures to silica and solvents can occur.

  • The pathogenesis of autoimmune disease related to occupational exposures is not fully elucidated but is likely to involve a key role for innate immune responses.

  • Occupational systemic autoimmune rheumatic diseases present a unique opportunity for disease prevention through the generation of new scientific knowledge, advocacy, workplace health and safety policy, and legislation.