Potential Risk Factors for Undifferentiated Connective Tissue Disease

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American Journal of Epidemiology Vol. 154, No. 7 : 610-617 Copyright © 2001 by The s Hopkins University School of Hygiene and Public Health

ORIGINAL CONTRIBUTIONS

Potential Risk Factors for Undifferentiated Connective Tissue Disease among Women: Implanted Medical Devices J. Laing, Schottenfeld,, V. Lacey, Jr., W. Gillespie, H. Garabrant,, C. , G. Heeringa, Kirsten H. Alcser and Maureen D. Mayes

Department of Internal Medicine, University of Michigan, Ann Arbor, MI.2 Department of Epidemiology, University of Michigan, Ann Arbor, MI.3 Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, MI.4 Department of Environmental Health Sciences, University of Michigan, Ann Arbor, MI.5 Institute for Social Research, University of Michigan, Ann Arbor, MI.6 Department of Internal Medicine, Wayne State University, Detroit, MI.

A case-control study was conducted among 205 women in Michigan and Ohio who were diagnosed with undifferentiated connective tissue disease (UCTD) to investigate the significance of self-reported past exposures to implanted silicone-containing or non-silicone-containing medical devices. The 205 UCTD cases were compared with 2,095 controls who were sampled by random digit dialing. When silicone-containing devices, including shunts and catheters, were analyzed collectively, a significant association was observed (odds ratio (OR) = 2.81, 95% confidence interval (CI): 1.34, 5.89). The odds ratio for exposure to breast implants was increased, but not significantly (OR = 2.22, 95% CI: 0.65, 7.57). Among the non-silicone-containing devices, artificial joints (OR = 5.01, 95% CI: 1.60, 15.71) and orthopedic metallic fixation devices (OR = 1.95, 95% CI: 1.05, 3.60) were associated with UCTD. The estimations of risk associated with implanted medical devices in UCTD cases were explored in a comparison with 660 scleroderma patients who were ascertained concurrently in Michigan and Ohio. In general, the associations that were observed with non-silicone-containing devices, and more specifically with the fixation devices, persisted in the comparison of UCTD cases with scleroderma patients. The studies conducted among populations in Michigan and Ohio are intended to stimulate new hypotheses, innovative approaches, and the fostering of understanding of the environmental determinants of autoimmune disease.

Key Words: breast implants • connective tissue diseases • orthopedic fixation devices ACR, American College of Rheumatology • ANA, antinuclear antibodies • CI, confidence interval • CNS, central nervous system • HCIA, Health Care Investment Analysts, Inc. • OR, odds ratio • UCTD, undifferentiated connective tissue disease • USF, United Scleroderma Foundation • WSU, Wayne State University

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Martha Murdock, DirectorNational Silicone Implant Foundation | Dallas Headquarters"Supporting Survivors of Medical Implant Devices"4416 Willow LaneDallas, TX 75244-7537