Silica exposure and autoimmune diseases.

There have long been case reports linking silica exposure to a variety of autoimmune diseases (systemic sclerosis, rheumatoid arthritis, lupus, chronic renal disease). Evidence of this association in larger epidemiologic studies has been increasing in the last decade. We summarize this evidence here, and present some plausible mechanisms which have been discussed in the literature. The link between silica exposure and autoimmune disease may have been missed in cohort mortality studies because autoimmune diseases are rarely underlying causes of death. Similarly, case-control studies of autoimmune diseases have often failed to consider occupational exposure to silica. Further research is needed in occupationally exposed populations to verify this association. The link between respirable silica exposure and autoimmune disease may have some bearing on the possible association between silicone breast implants and autoimmune disease, although the nature of the silica involved is quite different in the two situations.