AUTOANTIBODY TESTING IN PATIENTS WITH SILICONE IMPLANTS

Since 1938, when silicone was first synthesized, it has been in widesp read use, including as a base material for many biomedical implants an d devices. Silicone breast implants (SBI), the most popular silicone i mplants, have been in use for more than 30 years(35); however, during this decade a controversy over the safety of SBI has developed, a cont roversy that is still not resolved and has extended to other medical i mplants. At first, the controversy was about the potential association of SBI and connective tissue diseases (CTD); later, other rheumatic d iseases such as fibromyalgia (FM), myofascial syndromes, and chronic f atigue syndrome (CFS) were involved. Lately, an increasing number of d iseases, including neurologic diseases, nonspecific symptoms, and even the possibility of a novel disease caused by silicone have been menti oned. It will take many years before firm conclusions can be drawn; me anwhile, between 1 and 2 million women with SBI ask whether they are a t an increased risk of developing any of the many diseases in question , and what can be done to identify and prevent such risk. In this revi ew, the published evidence about the utility of autoantibody testing i n women with SBI and other silicone devices will be discussed. Because it is impossible to generalize published results to all women with SB I, discussion will be separated into symptomatic and asymptomatic wome n. Also, many immunologic abnormalities, clinical and investigational, have been reported in these women. This review will focus on clinical immunologic tests, mostly antinuclear antibodies (ANA), rheumatoid fa ctor (RF), and ANA profile, according to the following classification of symptoms: (1) local reactions; (2) nonimmunologic rheumatic disease s;and (3) definite/possible connective tissue diseases. Autoantibody s creening in women with SBI, antisilicone antibodies, and other silicon e devices also will be reviewed. This article presents the information available about autoantibody testing in women with silicone breast im plants. Definite connective tissue diseases, non-autoimmune rheumatic diseases and a possible novel disease are covered. Autoantibody testin g in asymptomatic women with breast implants, anti-silicone antibodies and other silicone implants are also discussed.