Silicone breast implants and depression, fibromyalgia and chronic fatigue syndrome in a rheumatology clinic population, 2019, Khoo et al

[Andy]

Abstract
Introduction

Silicone breast implants (SBI) may induce systemic autoimmune disease as part of autoimmune syndrome induced by adjuvants (ASIA). This syndrome bears similarities to fibromyalgia and chronic fatigue syndrome (CFS). We sought to determine whether there are any associations between SBI and depression, fibromyalgia and CFS in a rheumatology clinic population.

Methods
The electronic files of rheumatology clinic patients at the Royal Adelaide Hospital between 2000 and 2017 were searched for patients who had received SBI prior to rheumatological diagnosis. Demographics, diagnosis, implant history and whether the patient had depression, fibromyalgia or CFS were recorded. Controls were rheumatology clinic patients, half of whom had systemic sclerosis (SSc) and the other half had systemic lupus erythematosus (SLE). They were matched to cases 3:1 for age (within 2 years) and gender.

Results
Thirty patients had received SBI (mean age 47.9, 100% female). Twelve had a diagnosis of depression, 6 of fibromyalgia and 3 of CFS. Implant rupture was not associated with any of these (p = 1). There was no difference in the incidence of depression (p = 1), fibromyalgia (p = 0.76) or CFS (p = 0.3) between cases and SLE controls. When compared with SSc controls, there were significantly more patients with fibromyalgia and/or CFS in the case group (20.0% of cases vs 2.2% of SSc controls, p = 0.01) but no difference in depression (p = 0.12).

Conclusion
Fibromyalgia and CFS are more common in patients with silicone implants than SSc controls but not SLE controls. Prospective study of development of depression, fibromyalgia and CFS in recipients of SBI is required.

Paywalled at https://link.springer.com/article/10.1007/s10067-019-04447-y

 

[Trish]

The sample size (30 patients, 3 with CFS) and numbers with each condition seem far too small to draw any clear conclusions about prevalence of CFS in this group, let alone carry out any meaningful comparisons.

And surely if you want to work out the prevalence of CFS in people with implants, you need to look at the population of people with implants, not the sub-population attending a rheumatology clinic.

 

[mariovitali]

I think the following is interesting, looking through the "Liver Injury Hypothesis" for ME/CFS :

A 55‐year‐old woman with a 10‐year‐old mammary prosthesis developed Sjögren's syndrome (sicca syndrome, anti‐Ro, and salivary gland biopsy positivity) for 4 years and rupture of one side of the prosthesis for 1 year. After 3 months of moderate abdominal pain in the right hypochondrium, hyperthermia, pruritus, chronic fatigue, and myalgia, she was admitted to the emergency department. Physical examination showed pain on palpation of the right hypochondrium. Regarding laboratory findings, hepatic enzymes were elevated (alanine aminotransferase, 68 UI/L [reference value, 0‐31 UI/L]; aspartate aminotransferase, 50.6 UI/L [reference value, 0‐32 UI/L]) and anti‐mitochondrial antibodies were positive (1:80). The viral infection panel and anti–smooth muscle antibody were negative. Abdominal magnetic resonance imaging revealed cholecystitis and abnormal hepatic enhancement without focal lesions. On the basis of these findings, cholecystectomy and hepatic biopsy were performed and revealed hepatic infiltration by silicone

and

Silicone implants have been used in various medical devices such as intraocular lenses, artificial heart valves, testicular prostheses, joints, and breast implants.3 A possible association between silicone exposure and autoimmune diseases in genetically prone individuals has been described previously in many studies.4 The silicone can infiltrate body tissues even in the absence of rupture of the prosthesis, inducing a foreign body reaction characterized by activation of immune cells, fibrosis, and formation of silicone‐containing granulomas.

Link : https://aasldpubs.onlinelibrary.wiley.com/doi/full/10.1002/hep.29274

 

[Hip]

And surely if you want to work out the prevalence of CFS in people with implants, you need to look at the population of people with implants, not the sub-population attending a rheumatology clinic.

That's what the authors said.

Silicone is an immune modulator, used in some vaccines as an adjuvant. So possibly silicone implants might trigger ME/CFS in a way similar to the reported vaccine-triggered ME/CFS cases?

 

[inox]

There was no difference in the incidence of depression (p = 1), fibromyalgia (p = 0.76) or CFS (p = 0.3) between cases and SLE controls. When compared with SSc controls, there were significantly more patients with fibromyalgia and/or CFS in the case group (20.0% of cases vs 2.2% of SSc controls, p = 0.01) but no difference in depression (p = 0.12).

I don't understand their controls. Isn't both systemic lupus and systemic scleroses known to have fatigue as a symptom?

This could just as well thell us that SSc patients are less likely to get an additional CFS diagnosis?

A study supported by the Scleroderma Research Foundation found that over 75% of people with scleroderma, experienced fatigue, and for 61% of these, it was reported to be one of the most distressing symptoms of the condition.

https://www.sruk.co.uk/scleroderma/scleroderma-and-your-body/understanding-and-managing-fatigue/