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A Clinical and Immunologic Evaluation of Women with Silicone Breast Implants and Symptoms of Rheumatic Disease

Alan J. Bridges, MD; Carol Conley, BS; Grace Wang, BS; David E. Burns, MD; and Frank B. Vasey, MD
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From the University of Missouri-Columbia, the University of South Florida, and the James A. Hailey Veterans Administration Hospital, Tampa, Florida. Requests for Reprints: Alan J. Bridges, MD, H6/367 Clinical Sciences Center, University of Wisconsin Hospital, 600 Highland Avenue, Madison, WI 53792. Acknowledgments: The authors thank Frederick W. Miller, MD, PhD, Lori A. Love, MD, PhD, and Dr. Charles L. Puckett, MD, for scientific review. Dr. John Hewitt and Jane Johnson performed the statistical analyses. Grant Support: In part by grants from the Department of Medicine, University of Missouri-Columbia, and by the St. Petersburg Medical Clinic Foundation.

Copyright 2004 by the American College of Physicians

Ann Intern Med. 1993;118(12):929-936. doi:10.7326/0003-4819-118-12-199306150-00003
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Objective: To describe the clinical and serologic features of women with silicone breast implants who were referred for symptoms of rheumatic disease.

Design: A case series.

Setting: University and private rheumatology practices.

Patients: A total of 156 women with silicone breast implants and rheumatic disease complaints. Controls for the serologic studies included women with silicone implants and no rheumatic symptoms (n = 12) and women with fibromyalgia without silicone implants (n = 174).

Measurements: Complete physical examination and testing for immunoglobulins; complement; C-reactive protein; rheumatoid factor; and autoantibodies by indirect immunofluorescence, immunodiffusion, and Western blot.

Results: Three subgroups of patients were defined based on clinical and laboratory findings: joint and muscle pain (n = 95), joint swelling (n = 32), and connective tissue disease (n = 29). Most women had normal immunologic studies. The patients with joint swelling had mild, asymmetric, rheumatoid-factornegative synovitis that did not meet American College of Rheumatology criteria for rheumatoid arthritis. Fourteen patients had a scleroderma-like illness and anti-centromere or anti-PM-Scl antibodies by Western blot. Ten patients had a positive Western blot for BB polypeptide, a small nuclear ribonucleoprotein (snRNP), but did not meet criteria for systemic lupus erythematosus. No autoantibodies to known disease-related polypeptides were detected on Western blot in the control groups.

Conclusion: Most women with silicone implants and rheumatic complaints had normal results of serologic tests and nonspecific symptoms, suggesting no serious connective tissue disease. However, a subset of women had clinical signs and serologic tests that were unusual even for referred patients. These observations suggest, but cannot establish, that some women with silicone breast implants may develop atypical immunologic reactions.


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Figure 1.
Western blot of sera from patients with scleroderma and scleroderma-like disorders.

Lane 1 is the negative control. Lane 2 is the Scl-70 antibody control. Lane 3 is the PM-Scl antibody control, and lane 4 is the centromere antibody control. Lanes 5 to 18 represent patients with silicone implants. Lanes 5 to 8 represent patients with diffuse scleroderma, lanes 9 to 13 represent patients with intermediate scleroderma, and lanes 14 to 16 represent patients with limited scleroderma (CREST). Patients represented in lanes 7, 8, 9, 10, 11, 14, 15, and 16 have anticentromere antibodies. Patients represented in lanes 12 and 17 have anti-PM-Scl antibodies. Patients represented in lanes 5, 6, 13, and 18 show no apparent disease-associated antibodies on Western blot.

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Grahic Jump Location
Figure 2.
Western blot of sera from patients with early connective tissue disease.

Lane 1 represents monoclonal antibody Y12 to BB (B/B) and D polypeptides. Lane 2 represents monoclonal antibody Hoch-70 to the 70-kd polypeptide. Lane 3 represents a negative control, and lane 4 represents control sera with antibodies to 70-kd, A, BB, C, and D polypeptides. Lanes 5 to 14 represent the 10 patients with early connective tissue disease and antibodies to BB polypeptide. The patient represented in lane 5 also has antibodies to 70 kd and C polypeptides.

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