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Table 3. Health conditions other than silicosis associated with respirable crystalline silica exposure, with emphasis on artificial stone( AS) exposure
Condition |
Findings in all RCS-Exposed Workers |
Findings in AS Workers |
Dust-related Diffuse fibrosis( DDF) |
Silica exposure is an independent risk factor for UIP-pattern fibrosis, the form commonly associated with idiopathic pulmonary fibrosis( IPF). ~ 9 – 10 % of exposed workers show UIP |
Published case series of AS workers have not described UIP on CT scans, 4, 46, 74 though this does not exclude the possibility. |
Chronic Obstructive Pulmonary Disease( COPD) without classic silicosis.
170, 171
RCS is an independent risk factor, even in never-smokers. COPD is worse in smokers with silicosis than in smokers without silica exposure.
172 – 174
Lung Cancer IARC classifies RCS as Group 1 carcinogen. 175 Meta-analyses show dose-response relationship between silica exposure and lung cancer.
107, 108
Silicosarcoidosis 30 % of cases may be exposure-related. 95 Studies show consistent association with silica; biopsies reveal overlapping granulomas and silicotic nodules.
171, 176 – 179
Bacterial Pneumococcal pneumonia risk increases with pneumonia cumulative silica exposure. Exposure to silica dust was associated with increased odds of pneumococcal pneumonia( OR 2.53, 95 % CI
Mycobacterial Infections
Autoimmune Diseases
Chronic Kidney Disease( CKD)
1.49 – 4.32) 180 Silicosis increases risk of TB( RR ~ 4.0) 182 and nontuberculous mycobacterial( NTM) disease. 4, 183 Mechanism involves impaired macrophage clearance and elevated TNF-α. 184 Silica exposure linked to RA, systemic sclerosis, SLE, vasculitis. 54, 188 – 198 Likely mediated by silica-induced immune dysregulation. 199 Proposed mechanisms include direct injury and autoimmune effects. 201 Exposure duration linked to CKD risk; 202 increased mortality reported in silica-exposed workers.
203, 204
Obstructive or mixed ventilatory defects are found in 16 – 33 % of workers with AS silicosis. 4, 8, 46 Chinese AS workers had higher proportion of emphysema on imaging than non- AS workers, despite younger age and similar smoking prevalence. 166 Clinicians should suspect lung cancer in AS workers with asymmetric / enlarging nodules, cavitation, or systemic symptoms. 91 In California, 40 % of AS workers had granulomas on biopsy. 4 Frequent misdiagnosis of silicosis as idiopathic sarcoidosis in highexposure workplaces. 4, 6, 97 There is one case report of an AS case initially presenting with empyema. 181
9 % of AS silicosis patients in Israel and California had NTM; prevalence mirrors Brazilian mining cohorts. 4, 183, 185 Associated with advanced disease and higher mortality.
183, 186, 187
Autoimmune disease prevalence 20 – 30 % among AS workers with silicosis, substantially higher than general population.
46, 96, 165, 200
In multinational registry, ~ 10 % of AS silicosis patients had CKD, especially in older Israeli patients with advanced disease.
18, 46
Definitions: AS = artificial stone; CKD = chronic kidney disease; DDF = dust-related diffuse dust fibrosis; IARC = International Agency for Research on Cancer; NTM = non-tuberculous mycobacteria; PFT = pulmonary function test; RA = rheumatoid arthritis; RCS = respirable crystalline silica; RR = risk ratio; SLE = systemic lupus erythematosus; TB = tuberculosis; TNF-α = tumor necrosis factor-alpha; UIP = usual interstitial pneumonia
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