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Meta-Analysis
. 2022 Apr;62(2):333-345.
doi: 10.1007/s12016-021-08846-5. Epub 2021 Mar 2.

Systematic Review and Meta-analysis on the Association of Occupational Exposure to Free Crystalline Silica and Rheumatoid Arthritis

A Morotti  1 , I Sollaku  1 , F Franceschini  2   3 , I Cavazzana  2 , M Fredi  2   3 , E Sala  4 , G De Palma  5   6
Affiliations
Meta-Analysis

Systematic Review and Meta-analysis on the Association of Occupational Exposure to Free Crystalline Silica and Rheumatoid Arthritis

A Morotti et al. Clin Rev Allergy Immunol. 2022 Apr.

Abstract

• 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.

Keywords: Free crystalline silica; Meta-analysis; Rheumatoid arthritis; Silica.

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Figures

Fig. 1
Fig. 1
Flow chart of search and selection of studies included in the review and meta-analysis
Fig. 2
Fig. 2
Meta-analysis of all the selected studies on occupational exposure to FCS and RA
Fig. 3
Fig. 3
Meta-analysis of studies including seropositive (RA+) RA patients
Fig. 4
Fig. 4
Meta-analysis of studies including seronegative (RA−) RA patients
Fig. 5
Fig. 5
Meta-analysis of studies investigating interaction between occupational exposure to FCS, smoking habits, and seropositive (RA+) RA patients
See this image and copyright information in PMC

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