Re: Fw: (Revised) Important Silicone Breast Implant Info - Journal ofRheumatalogy 2003

[Guest guest]

I am very impressed with this artical Patty. Does this mean it has finally been proven, silicone causes fibromyalgia, chronic fatigue, depression, and chronic fatigue? Will all rheumatologist get this report? I have SS pending. I sent this to my family. I suffer all symptoms, I had two silicone ruptures, Dave & Patty <faussettdp@...> wrote:

> This one has all the references attached, and more content. .>> > -----Original Message-----> > From: Myrl> > Sent: Saturday, December 13, 2003 9:32 AM> > Subject: Important Silicone Breast Implant Info - Journal of> > Rheumatalogy 2003> >> > All-> > There has been a joint/group effort to get this information into your> > hands. It is significant information for those of us interested inbreast> > implant medical findings. Thanks to all that contributed to thiseffort!> >> > Myrl> >> > -----> >> > The Journal of Rheumatology 2003; 30:10 2092> >> > The bonfires of the silicone breast implant controversy in the 1990shave> > been reduced to coals in

2003. The burning medical and legal issues have> > been extinguished. The spark in North America occurred in 1979 when a> > woman in Pittsburgh developed an acute illness suggesting toxic shock> > immediately post implant placement. No organism could be cultured andshe> > had to have her silicone breast implants removed 10 days afterplacement.> > She made a complete recovery1.> >> > Case reports and case series as well as press coverage of this formerly> > emotionally charged issue resulted in epidemiologic studies focusing on> > defined connective tissue diseases as well as undefined symptomcomplexes.> > Studies of defined diseases were either negative2,3 or showed only asmall> > but statistically significant relative risk4. Studies of systemic lupus> > erythematosus (SLE) and systemic sclerosis did not show an association> > with

silicone breast implants, but studies of symptoms did (Table 1)5-10.> > Because of a lack of consistency in methodology of symptom searches andin> > study findings some reviewers do not believe there is fire to befound11.> > Since then, a Dow Corning-funded study (2496 reduction mammoplasty> > patients versus 1546 silicone breast implanted women, 1/6 of whom had> > saline-filled silicone envelope implants) has documented that all 28> > symptoms were increased in silicone patients (16 of 28 werestatistically> > increased)5. In a comparison study, there was a statistical correlation> > between local problems and systemic problems.> >> > Also important, in the first full article detailing the benefits of> > silicone breast implant removal on symptom expression, the authors> > cautiously interpreted their data as showing a "temporary"

improvementin> > that they had only 6 months of followup post-removal9. Our study with> > 21-month followup confirms and prolongs these observations12. Promptonset> > of local and systemic symptoms, delayed removal after becoming> > symptomatic, and ruptures found at the time of removal all predictdelayed> > improvement.> >> > Exercise-induced exacerbations of pain, fatigue, and bladderirritability> > help separate women with silicone-related symptoms from "personally> > driven" fibromyalgia, in which exercise helps.> >> > In women with defined diseases, case reports and case series showed a> > suspiciously high improvement rate post implant removal13,14. These> > observations suggested women could have a combination illness expressing> > both a naturally occurring defined rheumatic disease with co-expressing> >

silicone component. Rheumatologists were urged to suggest the> > consideration of silicone breast implant removal in women with SLE or> > scleroderma. Insurance companies who deny benefits to very symptomatic> > women who only worsen while implant removal is delayed particularly> > frustrate all concerned. The women become disabled, lose theirinsurance,> > and have no way to fund removal.> >> > The literature suggests that the vast majority of symptomatic women hada> > fibromyalgia/chronic fatigue-like illness, which has still not been> > defined. It is time for organized medicine to convene a group of> > clinicians who understand the disease (rheumatologists, plasticsurgeons,> > and others) and epidemiologists who know how to define the disease in> > order to document the medical necessity of implant removal. Eosinophilia> > myalgia, with

only 3500 sufferers, was defined within 4 years of the> > initial case reports. In Table 2, we propose criteria to be tested.Other> > authors have proposed and tested criteria, but they have not been> > published15.> >> > Dow Corning recently quietly sent settlement packages to distribute 4.6> > billion dollars to injured women. Other manufacturers including Bristol> > Myers Squibb, 3M, and Baxter have largely settled their cases as well.> >> > In this issue of The Journal, Dutch investigators throw Editorial Where> > There's Smoke There's Fire: The Silicone Breast Implant Controversy> > Continues to Flicker: A New Disease That Needs To Be Defined> >> > See Rupture of silicone gel breast implants and symptoms of pain and> > fatigue, page 2263> >> > Personal, non-commercial use only. The Journal of Rheumatology

Copyright©> > 2003. All rights reserved.> >> >> >> > Table 1. Symptoms/signs associated with rupture of silicone breast> > implant.> >> >> > Statistics> > OR RR> > 95% CI P> >> > I. Body ache> > 1. Anthralgia> > a. Painful joints for more than 3 mo5 1.3> > 1.0-1.5> > b. Joint pain6> > <0.005> > 2. Myalgia> >> > a. Muscle pain7> > <0.001> > b. Fibromyalgia8 2.7> > 1.4-5.2> > 3. Unspecified> > a. Body pain9> > 0.001> > b. Neck ache5 1.5> > 1.3-1.9> > c. Shoulder ache5 1.4> > 1.1-1.7> > d. Back ache5 1.2> > 1.0-1.5> > e. Hand pain7> > <0.001> > II. Abnormal fatigue5> > 1.4 1.1-1.7> > III.

Impaired cognition> > 1. Though problems7> > <0.001> > 2. Hard to find words5 1.3> > 1.0-1.8> > IV. Depression5> > 1.2 1.0-1.5> > V. Dry eyes> > 1. Burning eyes6> > <0.01> > 2. Recurrent sensation of sand or gravel in eyes5> > 2.2 1.3-3.8> > VI. Dry mouth for more than 3 months5 1.4> > 1.0-2.1> > VII. Skin abnormalities> > 1. Redness on cheeks5 1.8> > 1.2-2.8> > 2. Unspecified5 1.8> > 1.3-2.3> > a. Unspecified6> > <0.005> > VIII. Parenthesia> > 1. Tingling and numbness5> > 1.3

1.0-1.6> > 2. Numbness in the extremities7> > <0.001> > IX. Swollen glands under arms10> > <0.05> > X. Tender glands under arms10> > <0.01> > XI. Unexplained fever5> > 2.5 1.6-3.9> > XII. Hair loss5> > 1.3 1.0-1.8> > XIII. Headache7> > <0.001> > XIV. Morning stiffness2> > 1.81 1.11-2.95> >> > OR: odds ratio; RR: Relative risk; CI: confidence interval.> >> >> >> >> > [table 2 on next page]> > Table 2. Proposed definition of silicone related disorder.> >> >> > Main criteria> >> > * Silicone breast implant with local problems including> > tenderness, capsule formation, change in shape or position, and/orrupture> > of the

envelope> > * Chronic fatigue lasting 6 months> > * Myalgias with tender muscles> >> > Minor criteria> >> > * Postexertional symptom exacerbation> > * Livedo reticularis> > * Bladder dysfunction including dysuria, frequency, nocturia,> > hematuria, and interstitial cystitis> > * Dry eyes and/or mouth> > * Impaired cognition-short term memory> > * Paresthesias/neuropathic pain> > * Unexplained fever intermittently over 3 months> > * Arthralgia> > * Lymphadendopathy> > * Unrefreshing sleep> >__________________________________________________________________________> > ___________________> >> Vasey, et al: Editorial 2093>> Personal, non-commercial use only. The Journal of Rheumatology Copyright ©> 2003. All rights reserved.>> The Journal of Rheumatology

2003; 30:10 2094>> Fuel on the fire by further correlating the high rate of self reported> envelope rupture with statistically increased frequency and severity of> symptoms including muscle pain, joint pain, memory loss, andpost-exertional> malaise, among others. The mechanism behind this phenomenon remains> unproven; however, the loss of envelope integrity would allow a greaterload> of silicone/silica gel to escape into the> surrounding tissues, regional lymph nodes, and possibly into thebloodstream> (if the element silicon can be taken as a marker for silicone polymer).They> also reported compelling data to demonstrate that the symptom complex of> silicone breast implant recipients with chronic fatigue differed markedly> from those patients with the "naturally occurring" chronic fatigue> syndrome16. It's time to end the burning disagreements over siliconebreast>

implants. Happily, informed consent before silicone breast implantplacement> has gone from a few paragraphs to many pages. Nevertheless, we believe the> significant problems of eventual undetected silicone envelope rupture and> risk of systemic symptoms should dictate removal of silicone gel-filled> breast implants from the market as too dangerous for human use as the> physiologic equivalent of the injection of loose silicone gel into thehuman> body.>> An extensive informed consent does not deter women who are obtaining> silicone breast implants at a higher rate than ever. They do not appear to> understand that "saline implants" have a silicone envelope. Some of our> patients with "saline implants" have the same symptom complex and local> complications as patients with gel-filled implants, but they should besafer> because there is less silicone load and> any rupture releases

saline. Plastic surgeons as well as rheumatologistsand> clinical epidemiologists who are on the front lines in seeing thesepatients> need to be involved in the definition process. A definition that surgeons> and everyone else can use should improve insurance coverage and speed> implant removal in women requiring it.>> FRANK B. VASEY, MD, Professor and Director; S. ALIREZA ZARABADI, DO;MITCHEL> SELEZNICK, MD; LOUIS RICCA, MD, Division of Rheumatology, University of> South Florida, Tampa, Florida, USA>> Address reprint requests to Dr. F.B. Vasey, Division of Rheumatology,> University of South Florida, 12901 Bruce B. Downs Blvd., MDC 81,> Tampa, FL 33612.>> REFERENCES> 1. Uretsky BF, O'Brien JJ, Courtiss SH, et al. Augmentation mammoplasty> associated with a severe systemic reaction. Ann Plast Surg 1979;3:445-7.>> 2. SE, O'Fallon WM, Kurland

LT, Beard CM, Woods JE, Melton LJ.Risk> of connective tissue diseases and other disorders after breastimplantation.> N Engl J Med 1994;330:1697-702.>> 3. -Guerrero J, Colditz GA, Karlson EW, Hunter BJ, Speiterzer FE,> Liang MH. Silicone breast implants and the risk of connective tissue> diseases and symptoms. N Engl J Med 1995;332:1666-70. 4. Hennekens CH, Lee> IM, Cook HR, et al. Self-reported breast implants and connective tissue> diseases in female health professionals: A retrospective cohort study.JAMA> 1996;275:616-21.>> 5. Fryzeck JP, Signorello LB, Hakelius L, et al. Self-reported symptoms> among women after cosmetic breast implant and breast reduction surgery.> Plast Reconstr Surg 2001;107:206-13.>> 6. Giltay EJ, Moens HJB, Riley AH, Tan RG. Silicone breast prosthetics and> rheumatic symptoms: A retrospective follow up study. Ann Rheum

Dis> 1994;53:194-6.>> 7. Edworthy SM, L, Barr SG, Birdsell DC, Brant RF, Fritzler MJ. A> clinical study of the relationship between silicone breast implants and> connective tissue disease. J Rheumatol> 1998;25:254-60.>> 8. Brown SL, Pennello G, Berg WA, Soo MS, Middleton MS. Silicone gelbreast> implant rupture, extracapsular silicone, and health status in a population> of women. J Rheumatol 2001;28:996-1003.>> 9. Rohrich RJ, Kenkel JM, WP, Beran S, Conner WCH. A prospective> analysis of patients undergoing silicone breast implant explantation.Plast> Reconstr Surg 2000;105:2529-37.>> 10. Wells KE, Cruse CW, Baker JL, et al. The health status of women> following cosmetic surgery. Plast Reconstr Surg 1994;93:907-12.>> 11. Tugwell P, Wells G, J, et al. Do silicone breast implantscause> rheumatologic disorders? A

symptomatic review for a court appointednational> science panel. Arthritis Rheum> 2001;44:2477-84.>> 12. Vasey FB, Aziz NA, Havice DL, Wells AF. Prospective clinical status> comparison between women retaining gel breast implants vs. women removing> implants [abstract]. Arthritis Rheum 1996;39> Suppl:S52.>> 13. Vasey FB, Havice DL, Bocanegra TS, et al. Clinical findings in> symptomatic women with silicone breast implants. Semin Arthritis Rheum> 1994;24 Suppl 1:22-8.>> 14. Wallace DJ, Basbug E, Schartz E, et al. A comparison of systemic lupus> erythematosus and scleroderma patients with and without silicone implants.J> Clin Rheumatol 1996;2:257-61.>> 15. Colin M, Borenstein D, Espinoza L, Silverman S, G. Analysis of> preliminary operational criteria for systemic silicone related disease> (SSRD) [abstract]. Arthritis Rheum 1996;39>

Suppl:S51.>> 16. Vermeulen RCW, Scholte HR. Rupture of silicone gel breast implants and> symptoms of pain and fatigue. J Rheumatol>> 2003;30:2263-7.> Personal, non-commercial use only. The Journal of Rheumatology Copyright ©> 2003. All rights reserved.

[Guest guest]

,

Suggestion . . . make a copy of the report, send/take it to your doctor and, at the same time, make an appointment to see your doctor TO DISCUSS THE REPORT! . . . then ask your doctor for his/her treatment plan.

I have no idea of what the outcome will be, but . . . regardless, it should be interesting.

Hugs,

Rogene

michelle king <michellerking1@...> wrote:

I am very impressed with this artical Patty. Does this mean it has finally been proven, silicone causes fibromyalgia, chronic fatigue, depression, and chronic fatigue? Will all rheumatologist get this report? I have SS pending. I sent this to my family. I suffer all symptoms, I had two silicone ruptures, Dave & Patty <faussettdp@...> wrote: > This one has all the references attached, and more content. .>> > -----Original Message-----> > From: Myrl> > Sent: Saturday, December 13, 2003 9:32 AM> > Subject: Important Silicone Breast Implant Info - Journal of> > Rheumatalogy 2003> >> > All-> > There has been a joint/group effort to get this information into your> > hands. It is significant information for those of us interested inbreast> > implant medical findings. Thanks to all that contributed to thiseffort!> >> > Myrl> >> > -----> >> > The Journal of Rheumatology 2003; 30:10 2092> >> > The bonfires of the silicone breast implant controversy in the 1990shave> > been reduced to coals in

2003. The burning medical and legal issues have> > been extinguished. The spark in North America occurred in 1979 when a> > woman in Pittsburgh developed an acute illness suggesting toxic shock> > immediately post implant placement. No organism could be cultured andshe> > had to have her silicone breast implants removed 10 days afterplacement.> > She made a complete recovery1.> >> > Case reports and case series as well as press coverage of this formerly> > emotionally charged issue resulted in epidemiologic studies focusing on> > defined connective tissue diseases as well as undefined symptomcomplexes.> > Studies of defined diseases were either negative2,3 or showed only asmall> > but statistically significant relative risk4. Studies of systemic lupus> > erythematosus (SLE) and systemic sclerosis did not show an association> > with

silicone breast implants, but studies of symptoms did (Table 1)5-10.> > Because of a lack of consistency in methodology of symptom searches andin> > study findings some reviewers do not believe there is fire to befound11.> > Since then, a Dow Corning-funded study (2496 reduction mammoplasty> > patients versus 1546 silicone breast implanted women, 1/6 of whom had> > saline-filled silicone envelope implants) has documented that all 28> > symptoms were increased in silicone patients (16 of 28 werestatistically> > increased)5. In a comparison study, there was a statistical correlation> > between local problems and systemic problems.> >> > Also important, in the first full article detailing the benefits of> > silicone breast implant removal on symptom expression, the authors> > cautiously interpreted their data as showing a "temporary"

improvementin> > that they had only 6 months of followup post-removal9. Our study with> > 21-month followup confirms and prolongs these observations12. Promptonset> > of local and systemic symptoms, delayed removal after becoming> > symptomatic, and ruptures found at the time of removal all predictdelayed> > improvement.> >> > Exercise-induced exacerbations of pain, fatigue, and bladderirritability> > help separate women with silicone-related symptoms from "personally> > driven" fibromyalgia, in which exercise helps.> >> > In women with defined diseases, case reports and case series showed a> > suspiciously high improvement rate post implant removal13,14. These> > observations suggested women could have a combination illness expressing> > both a naturally occurring defined rheumatic disease with co-expressing> >

silicone component. Rheumatologists were urged to suggest the> > consideration of silicone breast implant removal in women with SLE or> > scleroderma. Insurance companies who deny benefits to very symptomatic> > women who only worsen while implant removal is delayed particularly> > frustrate all concerned. The women become disabled, lose theirinsurance,> > and have no way to fund removal.> >> > The literature suggests that the vast majority of symptomatic women hada> > fibromyalgia/chronic fatigue-like illness, which has still not been> > defined. It is time for organized medicine to convene a group of> > clinicians who understand the disease (rheumatologists, plasticsurgeons,> > and others) and epidemiologists who know how to define the disease in> > order to document the medical necessity of implant removal. Eosinophilia> > myalgia, with

only 3500 sufferers, was defined within 4 years of the> > initial case reports. In Table 2, we propose criteria to be tested.Other> > authors have proposed and tested criteria, but they have not been> > published15.> >> > Dow Corning recently quietly sent settlement packages to distribute 4.6> > billion dollars to injured women. Other manufacturers including Bristol> > Myers Squibb, 3M, and Baxter have largely settled their cases as well.> >> > In this issue of The Journal, Dutch investigators throw Editorial Where> > There's Smoke There's Fire: The Silicone Breast Implant Controversy> > Continues to Flicker: A New Disease That Needs To Be Defined> >> > See Rupture of silicone gel breast implants and symptoms of pain and> > fatigue, page 2263> >> > Personal, non-commercial use only. The Journal of Rheumatology

Copyright©> > 2003. All rights reserved.> >> >> >> > Table 1. Symptoms/signs associated with rupture of silicone breast> > implant.> >> >> > Statistics> > OR RR> > 95% CI P> >> > I. Body ache> > 1. Anthralgia> > a. Painful joints for more than 3 mo5 1.3> > 1.0-1.5> > b. Joint pain6> > <0.005> > 2. Myalgia> >> > a. Muscle pain7> > <0.001> > b. Fibromyalgia8 2.7> > 1.4-5.2> > 3. Unspecified> > a. Body pain9> > 0.001> > b. Neck ache5 1.5> > 1.3-1.9> > c. Shoulder ache5 1.4> > 1.1-1.7> > d. Back ache5 1.2> > 1.0-1.5> > e. Hand pain7> > <0.001> > II. Abnormal fatigue5> > 1.4 1.1-1.7> > III.

Impaired cognition> > 1. Though problems7> > <0.001> > 2. Hard to find words5 1.3> > 1.0-1.8> > IV. Depression5> > 1.2 1.0-1.5> > V. Dry eyes> > 1. Burning eyes6> > <0.01> > 2. Recurrent sensation of sand or gravel in eyes5> > 2.2 1.3-3.8> > VI. Dry mouth for more than 3 months5 1.4> > 1.0-2.1> > VII. Skin abnormalities> > 1. Redness on cheeks5 1.8> > 1.2-2.8> > 2. Unspecified5 1.8> > 1.3-2.3> > a. Unspecified6> > <0.005> > VIII. Parenthesia> > 1. Tingling and numbness5> > 1.3

1.0-1.6> > 2. Numbness in the extremities7> > <0.001> > IX. Swollen glands under arms10> > <0.05> > X. Tender glands under arms10> > <0.01> > XI. Unexplained fever5> > 2.5 1.6-3.9> > XII. Hair loss5> > 1.3 1.0-1.8> > XIII. Headache7> > <0.001> > XIV. Morning stiffness2> > 1.81 1.11-2.95> >> > OR: odds ratio; RR: Relative risk; CI: confidence interval.> >> >> >> >> > [table 2 on next page]> > Table 2. Proposed definition of silicone related disorder.> >> >> > Main criteria> >> > * Silicone breast implant with local problems including> > tenderness, capsule formation, change in shape or position, and/orrupture> > of the

envelope> > * Chronic fatigue lasting 6 months> > * Myalgias with tender muscles> >> > Minor criteria> >> > * Postexertional symptom exacerbation> > * Livedo reticularis> > * Bladder dysfunction including dysuria, frequency, nocturia,> > hematuria, and interstitial cystitis> > * Dry eyes and/or mouth> > * Impaired cognition-short term memory> > * Paresthesias/neuropathic pain> > * Unexplained fever intermittently over 3 months> > * Arthralgia> > * Lymphadendopathy> > * Unrefreshing sleep> >__________________________________________________________________________> > ___________________> >> Vasey, et al: Editorial 2093>> Personal, non-commercial use only. The Journal of Rheumatology Copyright ©> 2003. All rights reserved.>> The Journal of Rheumatology

2003; 30:10 2094>> Fuel on the fire by further correlating the high rate of self reported> envelope rupture with statistically increased frequency and severity of> symptoms including muscle pain, joint pain, memory loss, andpost-exertional> malaise, among others. The mechanism behind this phenomenon remains> unproven; however, the loss of envelope integrity would allow a greaterload> of silicone/silica gel to escape into the> surrounding tissues, regional lymph nodes, and possibly into thebloodstream> (if the element silicon can be taken as a marker for silicone polymer).They> also reported compelling data to demonstrate that the symptom complex of> silicone breast implant recipients with chronic fatigue differed markedly> from those patients with the "naturally occurring" chronic fatigue> syndrome16. It's time to end the burning disagreements over siliconebreast>

implants. Happily, informed consent before silicone breast implantplacement> has gone from a few paragraphs to many pages. Nevertheless, we believe the> significant problems of eventual undetected silicone envelope rupture and> risk of systemic symptoms should dictate removal of silicone gel-filled> breast implants from the market as too dangerous for human use as the> physiologic equivalent of the injection of loose silicone gel into thehuman> body.>> An extensive informed consent does not deter women who are obtaining> silicone breast implants at a higher rate than ever. They do not appear to> understand that "saline implants" have a silicone envelope. Some of our> patients with "saline implants" have the same symptom complex and local> complications as patients with gel-filled implants, but they should besafer> because there is less silicone load and> any rupture releases

saline. Plastic surgeons as well as rheumatologistsand> clinical epidemiologists who are on the front lines in seeing thesepatients> need to be involved in the definition process. A definition that surgeons> and everyone else can use should improve insurance coverage and speed> implant removal in women requiring it.>> FRANK B. VASEY, MD, Professor and Director; S. ALIREZA ZARABADI, DO;MITCHEL> SELEZNICK, MD; LOUIS RICCA, MD, Division of Rheumatology, University of> South Florida, Tampa, Florida, USA>> Address reprint requests to Dr. F.B. Vasey, Division of Rheumatology,> University of South Florida, 12901 Bruce B. Downs Blvd., MDC 81,> Tampa, FL 33612.>> REFERENCES> 1. Uretsky BF, O'Brien JJ, Courtiss SH, et al. Augmentation mammoplasty> associated with a severe systemic reaction. Ann Plast Surg 1979;3:445-7.>> 2. SE, O'Fallon WM, Kurland

LT, Beard CM, Woods JE, Melton LJ.Risk> of connective tissue diseases and other disorders after breastimplantation.> N Engl J Med 1994;330:1697-702.>> 3. -Guerrero J, Colditz GA, Karlson EW, Hunter BJ, Speiterzer FE,> Liang MH. Silicone breast implants and the risk of connective tissue> diseases and symptoms. N Engl J Med 1995;332:1666-70. 4. Hennekens CH, Lee> IM, Cook HR, et al. Self-reported breast implants and connective tissue> diseases in female health professionals: A retrospective cohort study.JAMA> 1996;275:616-21.>> 5. Fryzeck JP, Signorello LB, Hakelius L, et al. Self-reported symptoms> among women after cosmetic breast implant and breast reduction surgery.> Plast Reconstr Surg 2001;107:206-13.>> 6. Giltay EJ, Moens HJB, Riley AH, Tan RG. Silicone breast prosthetics and> rheumatic symptoms: A retrospective follow up study. Ann Rheum

Dis> 1994;53:194-6.>> 7. Edworthy SM, L, Barr SG, Birdsell DC, Brant RF, Fritzler MJ. A> clinical study of the relationship between silicone breast implants and> connective tissue disease. J Rheumatol> 1998;25:254-60.>> 8. Brown SL, Pennello G, Berg WA, Soo MS, Middleton MS. Silicone gelbreast> implant rupture, extracapsular silicone, and health status in a population> of women. J Rheumatol 2001;28:996-1003.>> 9. Rohrich RJ, Kenkel JM, WP, Beran S, Conner WCH. A prospective> analysis of patients undergoing silicone breast implant explantation.Plast> Reconstr Surg 2000;105:2529-37.>> 10. Wells KE, Cruse CW, Baker JL, et al. The health status of women> following cosmetic surgery. Plast Reconstr Surg 1994;93:907-12.>> 11. Tugwell P, Wells G, J, et al. Do silicone breast implantscause> rheumatologic disorders? A

symptomatic review for a court appointednational> science panel. Arthritis Rheum> 2001;44:2477-84.>> 12. Vasey FB, Aziz NA, Havice DL, Wells AF. Prospective clinical status> comparison between women retaining gel breast implants vs. women removing> implants [abstract]. Arthritis Rheum 1996;39> Suppl:S52.>> 13. Vasey FB, Havice DL, Bocanegra TS, et al. Clinical findings in> symptomatic women with silicone breast implants. Semin Arthritis Rheum> 1994;24 Suppl 1:22-8.>> 14. Wallace DJ, Basbug E, Schartz E, et al. A comparison of systemic lupus> erythematosus and scleroderma patients with and without silicone implants.J> Clin Rheumatol 1996;2:257-61.>> 15. Colin M, Borenstein D, Espinoza L, Silverman S, G. Analysis of> preliminary operational criteria for systemic silicone related disease> (SSRD) [abstract]. Arthritis Rheum 1996;39>

Suppl:S51.>> 16. Vermeulen RCW, Scholte HR. Rupture of silicone gel breast implants and> symptoms of pain and fatigue. J Rheumatol>> 2003;30:2263-7.> Personal, non-commercial use only. The Journal of Rheumatology Copyright ©> 2003. All rights reserved.