Do exposure to organic solvents precipitate rheumatic disease?

Clinical rheumatology, 1986, 5, N ~ 3

DO E X P O S U R E T O O R G A N I C SOLVENTS PRECIPITATE RHEUMATIC DISEASE ?

To the Editor: We would like to draw attention to some unsuspected findings made in a group of workers known to have been exposed to certain organic solvents in an iron-mine refinery in Northern Norway. About 10 years ago the workers in the vulcanizing department began complaining of symptoms consistent with acute and chronic organic solvent intoxication. In addition pain and swelling mostly in peripheral joints were frequently reported, as well as a "puffed up" sensation in the stomach and sometimes of the face. This finally led to an investigation in 1984 - 85 carried out by the Institute of Occupational Health, Oslo, and the University Hospital of Tromso. The inquiry showed the workers to have been exposed in narrow compartments to high concentrations of a mixture of organic solvents like trichloroethylene, toluene, ethylacetate, white spirit, methylenchloride, perchloroethylene, xylene, metoxyethanol, 1,1,1-trichloroethane, technical hexane, as well as other chemical substances like dithiocarbarnate and triphenyimethantriisocyanate. From 1968 until June 1984, 26 persons had been employed and later left their positions in the vulcanizing department. Of these, 10 women consented to be examined. One of the employees (See Table, patient no. 1) had probably been exposed considerably less than the others and had worked for most of the time in the vicinity of the vulcanizing department. The mean period of exposure was apprx. 27 months (range 10-48), mean age at examination 43 years (range 33-62), and mean time from end of exposure till medical examination 63 months (range 18-97). Two women developed a non-erosive polyarthritis while working in the Department. Both

421

showed an elevated erythrocyte sedimentation rate (ESR) at onset time, and the polyarthritis was still clinically present on ex~imination. One of these was seropositive and the other seronegative. Both showed a symmetrical affection of distal joints. Furthermore, 2 women had all the signs of a primary fibrositis syndrome, and 5 suffered from unspecific but strong arthralgias. In all, 9 out of the 10 women claimed to have joint pain on examination. Except for 3 cases with slight polyneuropathy, no neurological sequelae attributable to the exposure to organic solvents were found. Neuropsychological tests revealed 3 women with probable encephalopathy caused by the exposure. Without doubt there is a strict selection of persons in this study. The question remains, however, whether organic solvents or other chemical substances are capable of precipitating rheumatic diseases like polyarthritis and fibrositis. It is of importance to note that neither of the 2 women with polyarthritis had elevated acute phase parameters indicative of an inflammatory process at examination, and that the arthritis showed a tendency to subside. The subjective statement from the other women of joint swelling during exposure might be interpreted as a "transient arthritis", but there was no medical examination on these occasions to confirm this. This preliminary report appears to be the first to question a possible relationship between organic solvent intoxication and inflammatory joint disease - and possibly, the fibrositis syndrome. Further observations can be clarifying. R. OMDAL*, H. OLSEN**, S.R. BERGE***, K.E. STABELL***, *Rhettmatological Department ; **Neurological Department, University Hospital of Tromso, N-9012 Tromsa, Norway. ***Institute of Occupational Health, P.B. 8149 Dep., 0033 Oslo 1, Norway.

37

62

34

38

54

46

33

44

35

49

1

2

3

4

5

6

7

8

9

10

A

SF A

A

-

F A

A

F A

A

SA

A 9

Normal

Normal

-

Slight osteoarthrosis DIP No. 2 sin. Osteoarthrosis ineip. DIP 1-5 bilat.

Normal

Normal

2 small cysts in os navic, sin

Normal

Symptoms* X-Ray of hands

25

24

48 12

24

27

28

39

34

10

Exposure (months)

9

12

6 7

2

9

7

14

18

9

ESR (ram/h)

< 11

< 11

< 11 -

< 11

< 11

-

< 11

< 11

< 11

CRP (rag/l)

Neg

Neg -

-

-

-

-

-

Neg

HLAB 27

Latex 1 +

Waaler 1/4000

Normal Normal

Normal

Normal

Latex 1 +

Thyreoglob. 1/40

Normal

Normal

Immunology tests'*

Normal Psycho-organic syndrome ? Psycho-organic syndrome ?

Normal

Normal

Sensorimotor dysfunction

Psycho-organic syndrome

Normal

Normal

Neuropsych. tests

Raynaud's phen. for several years. Colon irritable

Polyneuropathy Exanthema Iridocyelitis 1978

Exanthema -

Photosensitivity

Polyneuropathy Exanthema Asthma bronch, Photosensitivity Conjunctivitis Canalis carpi dx. Degen. columna lumbalis

Palmar erythcma

years

Photosensitivity and Raynaud's phen. several

Other

** ANA, Waaler, RA-latex, quant, of immunoglobulins, cryoglobulins, cold agglutinins, a.b. against smooth muscle, mithochondrias, parietal cells, thyreoglobulin, thyreomicrosom.

* A = Arthralgia; F = Fibrositis syndrome; S = Synovitis;

Age (Y)

Patient

Table I

~o

o

c~ ~n

~"

~"