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A meta-analysis was conducted on relevant studies. We searched PubMed and Embase, search engines, for original articles published (from 1960 to November 2019) in any language. In addition, we also searched reference lists of included studies manually for additional relevant articles. Finally, twelve studies were included in the meta-analysis (seven case-control cases and five cohort studies). The odds risks and 95% confidence interval (CI) were calculated using a random effect meta-analysis. A primary meta-analysis (using a random effect model)\u2014regarding RA risk in subjects exposed to FCS\u2014yelled to an overall OR of 1.94 (95% CI 1.46\u20132.58). We also conducted three further meta-analysis, taking into account the presence of autoantibodies (anti-RF or anti-ACPA) and smoking habits and found a significant association between FCS and RA in both seropositive and seronegative subjects (OR 1.74, 95% CI 1.35\u20132.25 and OR 1.23, 95% CI 1.06\u20131.4, respectively) and in seropositive subjects which were smokers (OR 3.30, 95% CI 2.40\u20134.54). The studies that have investigated the association between RA and occupatational exposure to FCS are still scarce and the heterogeneity between the studies remains high. Some critical limitations have been identified within studies, among which, the methods for assessing exposure stand out. Although with due caution, our results confirm the hypothesis of an association between occupational exposure to FCS and RA development. There was an interaction between FCS and tobacco smoking in RA seropositive workers.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s12016-021-08846-5","type":"journal-article","created":{"date-parts":[[2021,3,2]],"date-time":"2021-03-02T16:03:47Z","timestamp":1614701027000},"page":"333-345","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":30,"title":["Systematic Review and Meta-analysis on the Association of Occupational Exposure to Free Crystalline Silica and Rheumatoid Arthritis"],"prefix":"10.1007","volume":"62","author":[{"given":"A.","family":"Morotti","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I.","family":"Sollaku","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Franceschini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I.","family":"Cavazzana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Fredi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Sala","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9821-3060","authenticated-orcid":false,"given":"G.","family":"De Palma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,3,2]]},"reference":[{"key":"8846_CR1","doi-asserted-by":"publisher","first-page":"18001","DOI":"10.1038\/nrdp.2018.1","volume":"4","author":"JS Smolen","year":"2018","unstructured":"Smolen JS, Aletaha D, Barton A et al (2018) Rheumatoid arthritis Nat Rev Dis Primers 4:18001","journal-title":"Rheumatoid arthritis Nat Rev Dis Primers"},{"key":"8846_CR2","doi-asserted-by":"crossref","unstructured":"Ot\u00f3n T, Carmona L (2020) The epidemiology of established rheumatoid arthritis [published online ahead of print, 2020 Jan 24]. 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