A CLINICAL AND IMMUNOLOGICAL EVALUATION OF WOMEN WITH SILICONE BREASTIMPLANTS AND SYMPTOMS OF RHEUMATIC DISEASE

Objective: To describe the clinical and serologic features of women wi th silicone breast implants who were referred for symptoms of rheumati c disease. Design: A case series. Setting: University and private rheu matology practices. Patients: A total of 156 women with silicone breas t implants and rheumatic disease complaints. Controls for the serologi c studies included women with silicone implants and no rheumatic sympt oms (n = 12) and women with fibromyalgia without silicone implants (n = 174). Measurements: Complete physical examination and testing for im munoglobulins; complement; C-reactive protein; rheumatoid factor; and autoantibodies by indirect immunofluorescence, immunodiffusion, and We stern blot. Results: Three subgroups of patients were defined based on clinical and laboratory findings: joint and muscle pain (n = 95), joi nt swelling (n = 32), and connective tissue disease (n = 29). Most wom en had normal immunologic studies. The patients with joint swelling ha d mild, asymmetric, rheumatoid-factor-negative synovitis that did not meet American College of Rheumatology criteria for rheumatoid arthriti s. Fourteen patients had a scleroderma-like illness and anti-centromer e or anti-PM-Scl antibodies by Western blot. Ten patients had a positi ve 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 sil icone implants and rheumatic complaints had normal results of serologi c tests and nonspecific symptoms, suggesting no serious connective tis sue disease. However, a subset of women had clinical signs and serolog ic tests that were unusual even for referred patients. These observati ons suggest, but cannot establish, that some women with silicone breas t implants may develop atypical immunologic reactions.