Is Male Rheumatoid Arthritis an Occupational Disease? A Review

Abstract

Background: Rheumatoid arthritis (RA) is a systemic, inflammatory disease with an estimated global prevalence of 0.3-1.0%. An unexplained association exists between low formal education and the development of RA independent of smoking. It is established that RA is initiated in the lungs and that various occupations associated with dust, fume and metal inhalation can increase the risk of RA development.

Objective: The objective of this review is to evaluate published clinical reports related to occupations associated with RA development. We highlight the concept of a "double-hit" phenomenon involving adsorption of toxic metals from cigarette smoke by dust residing in the lung as a result of various work exposures. We discuss the relevant pathophysiological consequences of these inhalational exposures in relation to RA associated autoantibody production.

Method: A thorough literature search was performed using available databases including Pubmed, Embase, and Cochrane database to cover all relative reports, using combinations of keywords: rheumatoid arthritis, rheumatoid factor, anti-citrullinated peptide antibody silica, dust, fumes, metals, cadmium, cigarette smoking, asbestos, mining, bronchial associated lymphoid tissue, heat shock protein 70, and adsorption.

Conclusion: We postulate that the inhalation of dust, metals and fumes is a significant trigger factor for RA development in male patients and that male RA should be considered an occupational disease. To the best of our knowledge, this is the first review of occupations as a risk factor for RA in relation to the potential underlying pathophysiology.

Keywords: Adsorption; Bronchial associated lymphoid tissue; Cadmium; Cigarette smoking; Dust; Inhalation; Occupation; Rheumatoid arthritis; Silica.

Fig. (1)

Literature retrieval flowchart.

Fig. (2)

COPD risk: interaction between smoking and vapour/gas/dust/fume (VGDF) exposure. Adapted from Blanc et al [40].

Fig. (3)

Risk interaction of ACPA+ RA in Swedish quarry workers with smoking and silica dust exposure, compared to unexposed never smoking controls, adapted from Stolt et al [11].

Fig. (4)

Relative RA risk: interaction between dust exposure and smoking amongst Swedish construction workers, adapted from Blanc et al [13].

Fig. (5)

Interaction of asphalt exposure and cigarette smoking on serum cadmium levels among Turkish asphalt workers, adapted from Atasoy et al. [88].