Rheumatoid arthritis, breast implants

There have been case-reports of a confirmed diagnosis of systemic sclerosis, rheumatoid arthritis, or systemic lupus erythematosus in patients with silicone breast implants (Silverstein et al., 1992 Sanchez-Guerrero et al., 1994 Cuellar et al., 1995 Field Bridges, 1996). However, no association between silicone breast implants and connective tissue disease has been seen in more than... 

Wolfe F, Anderson J Silicone filled breast implants and the risk of fibromyalgia and rheumatoid arthritis. J Rheumatol 26 2025-2028,1999 Yarbrough BE, Garrettson LK, Zolet DI, et al Severe central nervous system damage and profound acidosis in persons exposed to pentaborane. Clin Toxicol 23 519-536, 1985... 

In addition, silicone-containing medical devices, particularly breast prostheses, have been reported to cause serum-sickness-like reactions, scleroderma-like lesions, and an SLE-like disease termed human adjuvant disease [11,23]. Some patients may also present with granulomas and autoantibodies. Human adjuvant disease is a coimective tissue or autoimmune disease similar to that of adjuvant arthritis in rats and rheumatoid arthritis in humans. Autoimmime disease-like symptoms usually develop 2-5 y after implantation in a small percentage of people that receive implants, which may indicate that there is a genetic predisposition similar to that for... 

Although systemic sclerosis is the most commonly reported disorder occurring following silicone breast implantation, there have also been reports of systemic lupus erythematosus [43,44,46,50], Sjogren s syndrome [45], keratoconjunctivitis sicca [45], rheumatoid arthritis [4,34,43], polymyositis [43], overlap syndromes (including human adjuvant disease) [34,43,46,50,51], morphea [35,43], Hashimoto s thyroiditis [43,52], anticar-diolipin antibody syndrome [53], primary biliary cirrhosis [45] and toxic shock syndrome [54]. Unfortunately, it is impossible to tell, on the basis of case reports, whether the frequency of these events is greater than might be expected on the basis of chance alone (Table 7.1). 

Case-control studies retrospectively compare the frequency of breast implantation in women with and without the outcomes of interest. If, for example, connective tissue disorders were more likely to occur among women with breast implants, this would constitute some evidence for causation. Case-control studies typically require less time and resources than cohort studies. However, they are susceptible to many more biases than cohort studies [62]. The primary reason not to perform a case-control study here, however, is that a separate case-control study would be required for each of the outcomes of interest, i.e., a case-control study of systemic sclerosis, a case-control study of rheumatoid arthritis, etc. The... 

In June of 1994, a population-based retrospective cohort study was published which examined the risk of a variety of connective tissue diseases and other disorders after breast implantation [65]. In this study, all women in Olmsted County, Minnesota who received a breast implant between 1 January 1964 and 31 December 1991 (the case subjects) were studied. For each case subject, two women of the same age (within three years) from the same population who had not received a breast implant and who underwent a medical evaluation within two years of the date of the implantation in the case subject were selected as control subjects. Each woman s complete inpatient and outpatient medical records were interviewed for the occurrence of various connective tissue diseases (i.e., rheumatoid arthritis, systemic lupus erythematosus, Sjogren s syndrome, dermatomyositis, polymyositis, systemic sclerosis, ankylosing spondylitis. 

Three additional controlled studies have been presented and are published in abstract form [64,66,70]. As part of a prospective case-control study of the risk of rheumatoid arthritis, Dugowson et ai recruited 349 women with new-onset rheumatoid arthritis and 1456 similarly aged control women. Information about breast implants was obtained on both cases and controls and age-adjusted risk for a history of breast implants... 

Dugowson, C.E., Daling, J., Koepsell, T.D. et al (1992) Silicone breast implants and risk for rheumatoid-arthritis. Arthritis Rheum., 35, S66. (Abstract)... 

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