Key messages

• Occupational exposure to free crystalline silica and tobacco smoking are associated with an increased risk rheumatoid arthritis, with the evidence of an interaction in seropositive subjects.

• Further studies in the field are needed to support such association

We carried out a systematic search for all published epidemiological studies concerning the association between occupational exposure to free crystalline silica (FCS) and subsequent development of rheumatoid arthritis (RA). A meta-analysis was conducted on relevant studies. We searched PubMed and Embase, search engines, for original articles published (from 1960 to November 2019) in any language. In addition, we also searched reference lists of included studies manually for additional relevant articles. Finally, twelve studies were included in the meta-analysis (seven case-control cases and five cohort studies). The odds risks and 95% confidence interval (CI) were calculated using a random effect meta-analysis. A primary meta-analysis (using a random effect model)—regarding RA risk in subjects exposed to FCS—yelled to an overall OR of 1.94 (95% CI 1.46–2.58). We also conducted three further meta-analysis, taking into account the presence of autoantibodies (anti-RF or anti-ACPA) and smoking habits and found a significant association between FCS and RA in both seropositive and seronegative subjects (OR 1.74, 95% CI 1.35–2.25 and OR 1.23, 95% CI 1.06–1.4, respectively) and in seropositive subjects which were smokers (OR 3.30, 95% CI 2.40–4.54). The studies that have investigated the association between RA and occupatational exposure to FCS are still scarce and the heterogeneity between the studies remains high. Some critical limitations have been identified within studies, among which, the methods for assessing exposure stand out. Although with due caution, our results confirm the hypothesis of an association between occupational exposure to FCS and RA development. There was an interaction between FCS and tobacco smoking in RA seropositive workers.

中文翻译：

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游离结晶二氧化硅职业暴露与类风湿关节炎相关性的系统评价和荟萃分析

关键信息

•职业性暴露于游离结晶二氧化硅和吸烟与类风湿性关节炎风险增加有关，有证据表明在血清反应阳性受试者中存在相互作用。

•需要对该领域的进一步研究来支持这种关联

我们对所有已发表的关于职业暴露于游离结晶二氧化硅 (FCS) 与随后发展为类风湿性关节炎 (RA) 之间关系的流行病学研究进行了系统搜索。对相关研究进行了荟萃分析。我们在搜索引擎 PubMed 和 Embase 中搜索以任何语言发表的原创文章（从 1960 年到 2019 年 11 月）。此外，我们还手动搜索了纳入研究的参考文献列表以查找其他相关文章。最后，荟萃分析包括 12 项研究（7 项病例对照病例和 5 项队列研究）。使用随机效应荟萃分析计算优势风险和 95% 置信区间 (CI)。一项关于暴露于 FCS 受试者的 RA 风险的主要荟萃分析（使用随机效应模型）得出的总体 OR 为 1。94 (95% CI 1.46–2.58)。我们还进行了三项进一步的荟萃分析，考虑到自身抗体（抗 RF 或抗 ACPA）的存在和吸烟习惯，发现血清阳性和血清阴性受试者的 FCS 和 RA 之间存在显着关联（OR 1.74, 95% CI 1.35–2.25 和 OR 1.23, 95% CI 1.06–1.4，分别）和吸烟者的血清反应阳性受试者（OR 3.30, 95% CI 2.40–4.54）。研究 RA 与 FCS 职业暴露之间关系的研究仍然很少，研究之间的异质性仍然很高。在研究中已经确定了一些关键的局限性，其中，评估暴露的方法很突出。尽管谨慎行事，但我们的结果证实了 FCS 职业暴露与 RA 发展之间存在关联的假设。