Background: Silicone is considered biologically inert; thus it has been employed in many medical devices and nowadays is commonly used in plastic surgery for mammary prosthesis. The most common adverse reaction after silicone breast implant (SBI) is capsular contracture due to a foreign body reaction. Autoinmune Rheumatic Diseases (ARD) have been associated with SBI or siliconosis as part of the spectrum of Autoimmune/Inflammatory Syndrome Induced by Adjuvants (ASIA). Silicone is an adjuvant that may ‘bleed’ and subsequently may be a chronic stimulus to the immune.
Objectives: To determine the frequency of rheumatic diseases (ARD) and associated factors in patients with ASIA induced by SBI (ASIA-SBI).
Methods: This study was performed between 2012 to 2018 in a tertiary hospital from a cohort of 200 patients with ASIA (associated of oily substance, vaccines and siliconosis according to Shoenfeld criteria). We selected those patients with ASIA induced by SBI and clinical manifestations of any autoimmune disease. The clinical manifestations of ARD were evaluated and classified according to The American College of Rheumatology or EULAR criteria for some rheumatic diseases. We also investigated family history of autoimmune diseases, tobacco smoking coexisting allergies and comorbidities such as hypothyroidism, depression, anxiety and others. Main autoantibodies, histological findings were also evaluated. We used descriptive statistics for analysis.
Results: There were 30 women patients with mean age 48.5±16.3 46 years old, mean disease duration of disease 6±5.5 years. The mean time of appearance of clinical manifestations after SBI was 8 ±4.9 years. The rheumatic diseases (RD) or ARD were Systemic sclerosis (SSc) 7, Fibromyalgia (FM) 6, Systemic lupus erythematosus (SLE) 3, rheumatoid arthritis (RA) 6, overlap syndrome 2 (SSc plus SS and SLE plus SSc), Sjogren syndrome (SS) 1, Takayasu arteritis 1, Still disease 1, tunnel carpal syndrome 1, antiphospholipid syndrome 1 and angioedema and urticaria 1. We found family history of rheumatic disease in 40%, allergic history ( food, drugs) in 40% and smoking in 50%. Hypothyroidism was observed in 30% and anxiety 30%. Patients were treated according to the rheumatic disease. Ten cases had their prostheses removed because extracapsular ruptured implants, with re-implantation of new prosthesis in 8 patients. Two patients experienced improvement of complaints after explantation of the implant.
Conclusion: We found a prevalence of ASIA associated to SBI of 15%. The main RD were SSc, FM and RA. We observed an association with family history, allergies and smoking in these patients.
Further studies are necessary to determine if SBI has a cause –effect relationship in the rheumatic disease manifestations.
References  Jara LJ, García-Collinot G, Medina G, Cruz-Dominguez MD, Vera-Lastra O, Carranza-Muleiro RA, Saavedra MA. Severe manifestations of autoimmune syndrome induced by adjuvants (Shoenfeld’s syndrome). Immunol Res. 2016 Jul 13
 Colaris MJ, de Boer M,van der Hulst RR, Cohen Tervaert JW,Two hundreds cases of ASIA syndrome following silicone implants: a comparative study of 30 years and a review of current literature. Immunol Res. 2016 Jul 13.
 Watad A, Quaresma M, Brown S, Cohen Tervaert JW, Rodríguez-Pint I, Cervera R, Perricone C, Shoenfeld Y. Autoimmune/inflammatory syndrome induced by adjuvants (Shoenfeld’s syndrome) - An update. Lupus. 2017 Jan 1:961203316686406.
Disclosure of Interests: None declared
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