Lung cancer

Silicosis patients also at risk of scleroderma

Occupational exposure to silica dust can lead to accelerated early-onset scleroderma as well as silicosis, workers are being advised by a personal injury law firm.

Young workers in the stone cutting industry are developing autoimmune diseases such as scleroderma and rheumatoid arthritis that have been linked to silica dust exposure, according to  Shine Lawyers.

The company is urging physicians to ask patients about occupational exposure in patients presenting with scleroderma symptoms, as part of a wider campaign to address workplace safety in the stone cutting industry.

The hazards of silica dust exposure made headlines in 2017 when scores of stonemasons in Queensland were diagnosed with the often fatal lung disease silicosis, triggering an audit of Queensland’s manufacturing stone industry.

Speaking to the limbic, dust diseases special counsel Roger Singh from Shine Lawyers said the audit findings revealed that over 100 workers have contracted the potentially deadly lung disease with more than 550 workplace safety breaches. And workers in other states and territories are being impacted with a similar number of cases now emerging in Victoria he added.

The progressive and irreversible respiratory disease is caused by long-term exposure to silica dust, which is created when artificial or engineered stone – increasingly used as a cheaper alternative to marble benchtops – is cut.

But now Mr Singh warns that  cases of workers presenting with autoimmune compromise – particularly scleroderma – as a result of exposure to silica dust are also on the rise.

What’s more, patients are getting diagnosed at a younger age and with a more aggressive form of disease than those in the general population.

He says he has observed this after taking on scores of silicosis and other dust diseases workers compensation cases across Queensland.

“It’s a major issue because the workers I’m dealing with are in their 30s and 40s. To be suffering from diffuse scleroderma at such a young age is appalling to be dealt such a devastating blow.”

The youngest sufferer diagnosed so far is 36 years old; his first exposure commenced at age 22, recalls Mr Singh.

“He was involved in cutting and fabricating engineered stone. He’s now been diagnosed with sclerodactyly and synovitis, which is associated with a more aggressive and poor prognostic disease in the context of his confirmed scleroderma condition.”

According to Mr Singh the engineered stone products that stonemasons work with are comprised of 90-95% silica content.

“That’s massive and from my experience the toxicity of that level of exposure has caused a more rapid onset of the condition than otherwise would perhaps be the case,” he suggested.

Dr Wendy Stevens from the Rheumatology Unit at St Vincent’s Hospital in Melbourne is at the forefront of scleroderma research in Australia.

Speaking to the limbic Dr Stevens said there is medical evidence dating back to the 1950s looking at gold miners in South Africa, as well as small case series around the world, linking scleroderma with workers who have had a heavy exposure to silica dust.

“It’s not huge – lots of people working in mines during the time of these reports were silica exposed and didn’t go on to get scleroderma but a very small number of miners did and it was more than you would expect for the background population.

According to Dr Stevens those reports have always led to the thought that inhaled silica exposure may be a trigger for scleroderma. But it’s certainly not as strong an association as seen with respiratory associations and it’s certainly not as common, she maintains.

Pointing out that the disease is rare – affecting between five to six thousand people in Australia – Dr Stevens also said it is not one for which there is any cure or effective treatment. It can also take years to diagnose.

“It’s not a disease that’s simple to sort out – it’s more a constellation of clinical features, but they’re quite striking clinical features.”

Often a sudden onset of severe Raynaud’s phenomenon in a patient’s 30s or 40s is the first symptom along with swollen puffy and painful hands should ring alarm bells but is often mistaken for arthritis, she noted.

Ulcers on the fingers or toes and very tight thick patches of skin are hallmarks of the disease and in diffuse scleroderma scarring of the lungs, heart and kidneys can also occur leading to other complicated health problems.

Meanwhile, Mr Singh says Queensland has just this week announced a silicosis register and he’s pushing for a similar register for silica-related autoimmune diseases.

“There’s an alarming pattern emerging here; it needs to be tracked and monitored so the extent of the problem can be taken heed of and appropriate action taken to avoid any further instance of this nature

I come across people with diagnosis of mesothelioma 30-60 years after exposure but here we’re seeing diseases emerging a lot more expeditiously from the time of exposure to symptom onset and so the role out of rigorous regulation and national registers is something which needs to be placed as priority on a political agenda.”

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