Frequency of abnormal heavy metal blood levels in Wegener's granulomatosis

Previous studies suggested environmental exposures, including mercury (Hg) and lead (Pb), may be related to Wegener's granulomatosis. In this study, investigations were extended to include the measurement of heavy metals in blood samples from patients diagnosed with Wegener's. Diagnosis was confirmed by using the 1990 Classification Criteria for Wegener's granulomatosis established by the American College of Rheumatology (ACR). Using commercial lab testing, whole blood heavy metal screenings were obtained from patients, and results were then compared with validated subject self-report questionnaire estimates of exposure. Thirty-eight Wegener's patients were enrolled; 10 of the 38 exhibited abnormal lab values. In those 10 subjects 3 had elevated nickel (Ni), 7 with increased cobalt (Co), 3 with higher manganese, 1 with elevated copper, and 1 with increased Hg. Overall, the questionnaire results did not correlate with the blood heavy metal analysis. Approximately 26% of Wegener's subjects in this study displayed abnormal heavy metal levels. These findings are likely underestimates since blood levels are an insensitive means for assessing total body burden of heavy metals. From these preliminary studies it appears that elevated Co is a common finding in Wegener's patients but Ni and Hg were also found to be increased. The proportion of patients with abnormal heavy metal levels is more than expected by chance alone. In order to yield more definitive results, further analysis is needed with a larger data set, more controls and more sensitive measurements (hair, urine, or nail samples).