The South Boston Scleroderma and Lupus Study:
Investigating Environmental Exposures and Autoimmune Disease
By Theresa A. Cassidy, M.P.H.
Massachusetts Department of Public Health
Bureau of Environmental
Health Assessment
Summary: Scleroderma is a rare, autoimmune disease with an unknown
etiology. The epidemiology of scleroderma has been difficult to examine
because of the rarity of the disease, the lack of specific and sensitive
diagnostic tests for the disease, and the overlap of its symptoms with
other connective tissue diseases, including systemic lupus erythematosus
(SLE). There is little known about the role that environmental exposures
play in the risk of autoimmune diseases. The theory that environmental
agents trigger scleroderma and SLE comes from evidence of scleroderma-like
symptoms arising from exposure to or ingestion of certain chemicals. Evidence
of SLE and scleroderma clusters has also provided evidence that environmental
factors may contribute to the development of autoimmune diseases. Epidemiologic
studies have examined exposures to environmental hazards, such as groundwater
contamination with organic solvents, air pollution, and silica as plausible
etiologic factors. In 1998, South Boston residents contacted the Massachusetts
Department of Public Health (MDPH) with concerns over a seemingly alarming
number of patients with scleroderma and SLE in their community. The primary
aim of the South Boston Scleroderma and Lupus Study is to determine whether
there is an increased prevalence of scleroderma (systemic sclerosis) in
South Boston, and secondly to investigate potential etiologic factors,
including environmental factors, that may be contributing to the occurrence
of the disease in this community. This presentation discusses the South
Boston Scleroderma and Lupus Study including the rationale and methodology
used for the study as well as the environmental exposures under investigation.
Biography: Theresa Cassidy is Director of the Community Assessment
Program at the Massachusetts Department of Public Health. She holds a
masters degree in public health and environmental health sciences from
the Yale University School of Medicine and has over 10 years experience
in the field of public health. As Director of the Community Assessment
Program, Ms. Cassidy conducts investigations of suspected disease clusters
and environmental exposures in communities throughout Massachusetts. She
is also the principal investigator for a number of large epidemiologic
studies researching environmental links to disease including the Ashland
Nyanza Health Study and the South Boston Scleroderma and Lupus Study.
Ms. Cassidy has expertise in epidemiology, risk communication and health
education. She has been a featured speaker at a number of national and
local forums on these topics. Before joining the Massachusetts Department
of Public Health, Ms. Cassidy worked as a toxicologist and risk assessor
for a private environmental consulting firm where she specialized in assessing
health risks from hazardous waste sites in Massachusetts as well as evaluating
the health and safety of industrial products for consumer use.
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