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Abstract：
BACKGROUND: Silicosis is associated with an increased risk of developing systemic autoimmune rheumatic disease (SARD). The prognostic implications of this association are poorly characterized. The aim of this study was to determine the prevalence of SARD and autoimmune markers in a cohort of patients with exposure to silica and assess their impact on prognosis.
METHODS: We performed a prospective observational study of all patients attending the dedicated silicosis clinic of our pulmonology unit between 2009 and December 2017. Diagnosis was confirmed by a rheumatologist according to Spanish Rheumatology Society criteria. Autoimmune markers, pulmonary function tests, radiological progression, visits to the emergency department and primary care center, and hospital admissions for respiratory causes, and mortality were analyzed.
RESULTS: Overall, 489 cases of silicosis and 95 cases of exposure were studied. In total, 54 (11.0%) patients with silicosis had SARD: 12 (2.4%) rheumatoid arthritis, 10 (2.0%) systemic lupus erythematosus, 10 (2.0%) systemic sclerosis, 3 (0.6%) Sjögren syndrome, 2 (0.4%) vasculitis associated with anti-neutrophil cytoplasmic antibodies (ANCA +), 6 (1.2%) psoriatic arthritis, 3 (0.6%) ankylosing spondylitis, and 8 (1.6%) other autoimmune diseases with no special features. The patients with SARD visited the emergency room more often (63.0% vs. 42.5%; p = 0.004), and progressed more rapidly (22.2 vs. 11.7%; p = 0.030).
CONCLUSIONS: The presence of systemic rheumatic autoimmune diseases involves radiological progression and a higher clinical impact.
METHODS: We performed a prospective observational study of all patients attending the dedicated silicosis clinic of our pulmonology unit between 2009 and December 2017. Diagnosis was confirmed by a rheumatologist according to Spanish Rheumatology Society criteria. Autoimmune markers, pulmonary function tests, radiological progression, visits to the emergency department and primary care center, and hospital admissions for respiratory causes, and mortality were analyzed.
RESULTS: Overall, 489 cases of silicosis and 95 cases of exposure were studied. In total, 54 (11.0%) patients with silicosis had SARD: 12 (2.4%) rheumatoid arthritis, 10 (2.0%) systemic lupus erythematosus, 10 (2.0%) systemic sclerosis, 3 (0.6%) Sjögren syndrome, 2 (0.4%) vasculitis associated with anti-neutrophil cytoplasmic antibodies (ANCA +), 6 (1.2%) psoriatic arthritis, 3 (0.6%) ankylosing spondylitis, and 8 (1.6%) other autoimmune diseases with no special features. The patients with SARD visited the emergency room more often (63.0% vs. 42.5%; p = 0.004), and progressed more rapidly (22.2 vs. 11.7%; p = 0.030).
CONCLUSIONS: The presence of systemic rheumatic autoimmune diseases involves radiological progression and a higher clinical impact.
摘要：
背景：矽肺与发生全身性自身免疫性风湿性疾病（SARD）的风险增加有关。这种关联的预后意义尚不明确。这项研究的目的是确定暴露于二氧化硅的患者队列中SARD和自身免疫标志物的患病率，并评估其对预后的影响。
方法：我们在2009年至2017年12月期间对我们肺科专用矽肺诊所的所有患者进行了一项前瞻性观察性研究。诊断由风湿病学家根据西班牙风湿病学会标准确认。自身免疫标志物,肺功能检查,放射学进展，参观急诊科和初级保健中心，以及因呼吸道原因入院，和死亡率进行了分析。
结果：总体而言，研究了489例矽肺和95例暴露。总的来说,54例（11.0％）矽肺患者患有SARD：12例（2.4％）类风湿性关节炎，10（2.0％）系统性红斑狼疮，10（2.0％）系统性硬化症，3（0.6%）干燥综合征，2（0.4％）与抗中性粒细胞胞浆抗体（ANCA）相关的血管炎，6（1.2％）银屑病关节炎，3（0.6%）强直性脊柱炎，和8（1.6％）其他无特殊特征的自身免疫性疾病。SARD患者就诊于急诊室的频率更高（63.0%vs.42.5%；p=0.004)，并且进展更快(22.2vs.11.7%；p=0.030）。
结论：全身性风湿性自身免疫性疾病的存在涉及放射学进展和更高的临床影响。
方法：我们在2009年至2017年12月期间对我们肺科专用矽肺诊所的所有患者进行了一项前瞻性观察性研究。诊断由风湿病学家根据西班牙风湿病学会标准确认。自身免疫标志物,肺功能检查,放射学进展，参观急诊科和初级保健中心，以及因呼吸道原因入院，和死亡率进行了分析。
结果：总体而言，研究了489例矽肺和95例暴露。总的来说,54例（11.0％）矽肺患者患有SARD：12例（2.4％）类风湿性关节炎，10（2.0％）系统性红斑狼疮，10（2.0％）系统性硬化症，3（0.6%）干燥综合征，2（0.4％）与抗中性粒细胞胞浆抗体（ANCA）相关的血管炎，6（1.2％）银屑病关节炎，3（0.6%）强直性脊柱炎，和8（1.6％）其他无特殊特征的自身免疫性疾病。SARD患者就诊于急诊室的频率更高（63.0%vs.42.5%；p=0.004)，并且进展更快(22.2vs.11.7%；p=0.030）。
结论：全身性风湿性自身免疫性疾病的存在涉及放射学进展和更高的临床影响。
