arthritis & rheumatism study

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ARTHRITIS AND RHEUMATISM VOL. 33 PG. 5156 1990

" SILICONE-ASSOCIATED CONNECTIVE TISSUE DISEASE (CTD) FOLLOWING

MAMMOPLASTY: CLINICAL COURSE AFTER IMPLANT REMOVAL " BY PINDARO

MARTINEZ-OSUNA, LUIS R. ESPINOZA, JOHN P. GRESH, MITCHEL SELEZNICK,

BERNARD GERMAIN, FRANK B. VASEY. UNIVERSITY OF SOUTH FLORIDA, TAMPA,

FL 33612.

WE REPORT 12 FEMALES, AGES 37-64, WHO DEVELOPED CTD 5 MO-25 YR AFTER

IMPLANTATION OF SILICONE-BASED MAMMARY PROSTHESES (11 BILATERAL, 1

UNILATERAL), AND WHO IMPROVED COMPLETELY (7) OR PARTIALLY (4) WHEN

THESE WERE REMOVED.

ONLY ONE DID NOT IMPROVE. MALAISE AND UNEXPLAINED CHRONIC FATIGUE

WERE STRIKINGLY PERSISTENT IN ALL.

OF THOSE WITH COMPLETE RESOLUTION 3 HAD DEVELOPED PSS WITH RAYNAUD

AND + ANA; ONE OF THEM HAD REFRACTORY HYPERTENSION THAT ALSO

RESOLVED.

ONE HAD POLYSEROSITIS, SCLERODACTYLY, AND + ANA; ANOTHER DEVELOPED A

RIGHT THORACIC OUTLET SYNDROME AFTER RIGHT MAMMOPLASTY ( THAT HAD

NOT IMPROVED WITH RIB RESECTION), MYALGIAS, ARTHRALGIAS, AND

SYNOVITIS.

THE LAST HAD FIBROMYALGIA (FM).

ALL THE CLINICAL AND LABORATORY ABNORMALITIES DISAPPEARED AND THERE

HAS BEEN NO RELAPSE AFTER 4 MO-4 YR OF FOLLOW-UP.

OF THE 4 WITH PARTIAL RESPONSE TO REMOVAL (AT 9 MO-2 YR OF FOLLOW-

UP) ONE HAD DEVELOPED BIBASILAR INFILTRATES, SYNOVITIS, AND FM; ONE

HAD SYNOVITIS, MALAR RASH, SICCA SYNDROME, AND PSS-LIKE SKIN CHANGES

WITH RAYNAUD; ONE HAD KNEE AND ANKLE SYNOVITIS, AND PARIETAL CHEST

PAIN; ONE HAD FM AND CERVICAL LYMPHADENOPATHY.

THE PATIENT WHO HAS HAD NO IMPROVEMENT 19 MO AFTER REMOVAL HAD

DEVELOPED FM, SACROILITIS, AND + ANA. ANTISILICONE ANTIBODIES (SOLID-

PHASE ELISA) WERE + IN 3/3 TESTED. SILICONE-ASSOCIATED CTD IS

DIVERSE, RESEMBLING PSS, RA, SLE, AN UNDIFFERENTIATED CTD, AND FM,

AND CAN OFTEN BE INCAPACITATING.

AN IMMUNE REACTION MAY BE TRIGGERED BY SILICONE OR RELATED

METABOLITES.

WE PROPOSE THAT REMOVAL OF THE IMPLANTS IS WARRANTED BECAUSE THE

SYMPTOMS WILL ABATE IN THE MAJORITY OF THE PATIENTS