A Review on Current Challenges and Knowledge Gaps in Artificial Stone Silicosis

The global emergence of artificial stone (AS) silicosis represents a critical occupational health challenge. The aim of this systematic review is to provide an overview of the clinical, functional, radiological, and occupational characteristics of patients affected by AS silicosis at the time of diagnosis, and to identify current knowledge gaps to guide future research.

A systematic review following PRISMA guidelines was conducted using PubMed and Scopus databases.

Forty-eight percent of the analyzed studies had as their main focus the clinical characteristics of the disease, which affects relatively young workers (41.9 ± 5.6 years at diagnosis) with a mean duration of exposure of 13.5 ± 4.1 years. At the time of diagnosis, pulmonary function was normal in 53.4% of the cases. Among patients with altered respiratory parameters, the most frequent impairment was a reduction in lung diffusion capacity for carbon monoxide (DLCO [39.2%]), followed by a restrictive spirometry pattern (33.3%). Radiologically, although simple silicosis was the most common finding, over one-quarter of patients (28.6% ± 15.5%) presented with severe disease characterized by progressive massive fibrosis. No reliable biomarkers are available for effective screening. Although industrial hygiene studies with objective data were few, all demonstrated inadequately controlled dust emission and poor work practice education.

AS silicosis is an aggressive condition that is frequently undetected early by standard functional tests or chest radiography. The main research gaps and uncertainties are not only in effective preventive measures and early diagnostic tools but also in prognostic aspects. Future research must prioritize the improvement of risk assessment strategies and the development of alternative safe materials to replace AS.