Reviews
An update on occupational exposures in systemic sclerosis: a narrative review on risk factors and characteristic disease phenotypes in silica- and organic solvent-exposed patients
R. Govender1, E. Gotelli2, E. Hysa3, R. Campitiello4, M. Vandycke5, T. Du Four6, V. Smith7
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Medical Specialties (Di.M.I.), University of Genova; and IRCCS Ospedale Policlinico San Martino, Genova, Italy.
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Medical Specialties (Di.M.I.), University of Genova, Italy.
- Laboratory of Experimental Rheumatology and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Medical Specialties (Di.M.I.), University of Genova; and IRCCS Ospedale Policlinico San Martino, Genova, Italy.
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.
- Department of Internal Medicine, Ghent University, Ghent; Department of Internal Medicine, Ghent University Hospital, Ghent; and Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Centre, Ghent, Belgium. vanessa.smith@ugent.be
CER13
2025 Vol.2, N°1
PI 0026, PF 0033
Reviews
Received: 31/05/2025
Accepted : 22/07/2025
In Press: 28/07/2025
Published: 30/07/2025
Abstract
Occupational exposures, particularly silica and organic solvents, have been implicated in the aetiopathogenesis of systemic sclerosis (SSc). Epidemiological studies suggest that these exposures may trigger immune activation with subsequent development of inflammation, fibrosis and clinically relevant disease. However, the relationship between specific exposures and distinct SSc phenotypes remains poorly defined due to recall bias, exposure misclassification and reliance on self-reported data. This narrative review summarises, in particular, the current literature on silica and organic solvent exposure and its prevalence in various global SSc cohorts with the aim to identify potential demographic and clinical risk factors. Despite the lack of standardised reporting of quantitative exposure information, most studies show an association between silica and organic solvent exposure and severe SSc disease phenotypes. Major organ involvement including cardiac involvement, severe interstitial lung disease (ILD), renal crises and severe gastrointestinal involvement by Medsger severity score have been linked to cumulative exposure scores with potentially higher mortality rates and poorer prognosis in this subset of patients. The finding of a strong association between male gender and silica or solvent exposure in a predominantly female-driven disease represents an important risk factor that should prompt the attending clinician to find a possible exposure link.
