Silicoarthritis: issues of early diagnosis, prevention

Background. The severity of the course of silicosis is aggravated by the addition of complications; one of the serious and rare complication of silicosis is silicoarthritis or Kaplan’s syndrome (KS), which accounts for 0.1-0.6% of all cases of silicosis. Silicoarthritis significantly reduces the quality of the life of patients and leads to early and persistent disability.

Aim. To establish the most significant methods of diagnosing silicoarthritis for early detection of the disease and prevention of complications.

Materials and methods. The article presents clinical cases of silicosis and its rare complication - SC. The basis for the diagnosis of this pathology is X-ray, immunological and functional methods.

Results. In patients with more than 5 years of experience exposed to aerosols of fibrogenic action, crystalline silicon dioxide, with an excess of the MPC level from 2.3 to 4 times on the basis of MSCT of the lungs, during which multiple polymorphic foci with a diameter of 2 up to 10 mm, partly merging with each other into peribronchovascular couplings, as well as perifocal areas of reduced airiness like ground glass and thickening of the axial interstitium, a diagnosis of late silicosis, stage 2 nodular form was established, the diagnosis was confirmed by biopsy data. In dynamics, after 5 years, arthralgic complaints joined. On the basis of immunological (increased TNF-alpha, IL-1b), X-ray examination (osteoarthritis of the distal and proximal interphalangeal, wrist, metatarsophalangeal joints), the diagnosis was clarified as Silicoarthritis: Kaplan’s syndrome.

Conclusion. Diagnosis of silicosis and its complications at the preclinical stage in workers who have been in contact with silica dust for 5 years or more should include: MSCT of the lungs, determination of TNF-alpha, IL-1b, rheumatoid factor, and a study of respiratory function.

1. Occupational pathology: national guidelines. Ed. Izmerova N. F. M.: GEOTAR-Media. 2011. (in Russ.)

2. Occupational respiratory diseases: national guidelines. Ed. Izmerova N. F., Chuchalina A. G. M.: GEOTAR-Media. 2015. (in Russ.)

3. Martínez González C, Prieto González A, García Alfonso L, et all. Silicosis in Artificial Quartz Conglomerate Workers. Arch Bronconeumol. 2019; 55 (9):459–464. doi: 10.1016/j.arbres.2019.01.017

4. Shtraichman O, Kramer MR. Artificial stone silicosis: the Israel epidemic, current view. Harefuah. 2017; 156 (8):517–521.

5. Ferrante P. Asbestosis and silicosis hospitalizations in Italy (2001-2015): results from the National Hospital Discharge Registry. Eur J Public Health. 2019; 29 (5):876–882. doi: 10.1093/eurpub/ckz003

6. Barnes H, Goh NSL, Leong TL, Hoy R. Silica-associated lung disease: An old-world exposure in modern industries. Respirology. 2019; 24 (12):1165–1175. doi: 10.1111/resp.13695

7. Skvortsov VV, Muradova HM, Satueva EZh, Fateeva OV. Silicosis as a representative of pneumoconiosis: a therapist’s view. Therapist. 2019; 4: 14–20 (In Russ)

8. Sürmelİ Z, Oruçoğlu N. Erasmus syndrome: systemic sclerosis and silicosis co-occurrence. Sarı Int J Rheum Dis. 2018; 21 (6):1326–1329. doi: 10.1111/1756-185X.13296

9. Cohen RA, Patel A, Green FH. Lung disease caused by exposure to coal mine and silica dust. Semin Respir Crit Care Med. 2008; 29 (6):651–661. doi: 10.1055/s-0028-1101275

10. Leung CC, Yu IT, Chen W. Silicosis. Lancet. 2012; 379 (9830): 2008–2018. doi: 10.1016/S0140-6736(12)60235-9

11. Velichkovskii BT. Molekulyarnye i kletochnye mekhanizmy razvitiya zabolevanii organov dykhaniya pylevoi etiologii. Izd-vo Rossiiskogo gosudarstvennogo meditsinskogo uni-versiteta (RGMU). 1997 (In Russ)

12. Federal’nye klinicheskie rekomendatsii po diagnostike, lecheniyu i profilaktike pnevmokoniozov. URL: http://docplayer.ru/29496838-Rekomendacii-po-diagnostike-lecheniyu-iprofilaktike-pnevmokoniozov.html. [date of access: 29 May, 2018]. (In Russ.)

13. Babanov SA, Averina OM. Diagnostics, treatment and prevention of occupational lung diseases. Breast cancer. 2012; 6: 306–312. URL: https://www.rmj.ru/articles/bolezni_dykhatelnykh_putey [date of access: 20 August, 2019] (in Russ.)

14. Zhestkov AV. Clinical and immunological manifestations of dusty lung diseases: Dis. doctor of medical sciences. Samara, 2010; 32. (in Russ.)

15. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coateset A. et al. Standartisation of spirometry. Eur Respir. J. 2005; 26 (2): 319–338. doi: 10.1183/09031936.05.00034805

16. Jun JS, Jung JI, Kim HR, Ahn MI, Han DH, Koet JM et al. Complications of pneumoconiosis: radiologic overview. Eur J Radiol. 2013; 82 (10): 1819–1830. doi: 10.1016/j.ejrad.2013.05.026

17. Order of the Ministry of Health of Russia dated January 28, 2021 N 29n «On approval of the Procedure for conducting mandatory preliminary and periodic medical examinations of employees, provided for in part four of Article 213 of the Labor Code of the Russian Federation, a list of medical contraindications to work with harmful and (or) hazardous production factors, as well as work in the performance of which mandatory preliminary and periodic medical examinations are carried out «(Registered in the Ministry of Justice of Russia on January 29, 2021 N 62277) URL: http://www.consultant.ru/document/cons_doc_LAW_375353 [date of access: 20 August, 2019] (in Russ.)

18. Fernández Álvarez R, Martínez González C, Quero Martínez A, et all. Guidelines for the diagnosis and monitoring of silicosis. Arch Bronconeumol. 2015; 51 (2):86–93. doi: 10.1016/j.arbres.2014.07.010

19. Krefft S, Wolff J, Rose C. Silicosis: An Update and Guide for Clinicians. Clin Chest Med. 2020; 41 (4):709–722. doi: 10.1016/j.ccm.2020.08.012

20. Zhao H, Wang Y, Qiu T, Liu W, Yao P. Autophagy, an important therapeutic target for pulmonary fibrosis diseases. Clin Chim Acta. 2020; 502:139–147. doi: 10.1016/j.cca.2019.12.016

21. Order of the Ministry of Health of Russia dated January 28, 2021 N 29n «On approval of the Procedure for conducting mandatory preliminary and periodic medical examinations of employees, provided for in part four of Article 213 of the Labor Code of the Russian Federation, a list of medical contraindications to work with harmful and (or) hazardous production factors, as well as work in the performance of which mandatory preliminary and periodic medical examinations are carried out «(Registered in the Ministry of Justice of Russia on January 29, 2021 N 62277) URL: http://www.consultant.ru/document/cons_doc_LAW_375839. [date of access: 20 August, 2019]