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Post-September 11, 2001, Incidence of Systemic Autoimmune Diseases in World Trade Center-Exposed Firefighters and Emergency Medical Service Workers

Webber, Mayris P; Moir, William; Crowson, Cynthia S; Cohen, Hillel W; Zeig-Owens, Rachel; Hall, Charles B; Berman, Jessica; Qayyum, Basit; Jaber, Nadia; Matteson, Eric L; Liu, Yang; Kelly, Kerry; Prezant, David J
OBJECTIVE: To estimate the incidence of selected systemic autoimmune diseases (SAIDs) in approximately 14,000 male rescue/recovery workers enrolled in the Fire Department of the City of New York (FDNY) World Trade Center (WTC) Health Program and to compare FDNY incidence to rates from demographically similar men in the Rochester Epidemiology Project (REP), a population-based database in Olmsted County, Minnesota. PATIENTS AND METHODS: We calculated incidence for specific SAIDs (rheumatoid arthritis, psoriatic arthritis, systemic lupus erythematosus, and others) and combined SAIDs diagnosed from September 12, 2001, through September 11, 2014, and generated expected sex- and age-specific rates based on REP rates. Rates were stratified by level of WTC exposure (higher vs lower). Standardized incidence ratios (SIRs), which are the ratios of the observed number of cases in the FDNY group to the expected number of cases based on REP rates, and 95% CIs were calculated. RESULTS: We identified 97 SAID cases. Overall, FDNY rates were not significantly different from expected rates (SIR, 0.97; 95% CI, 0.77-1.21). However, the lower WTC exposure group had 9.9 fewer cases than expected, whereas the higher WTC exposure group had 7.7 excess cases. CONCLUSION: Most studies indicate that the healthy worker effect reduces the association between exposure and outcome by about 20%, which we observed in the lower WTC exposure group. Overall rates masked differences in incidence by level of WTC exposure, especially because the higher WTC exposure group was relatively small. Continued surveillance for early detection of SAIDs in high WTC exposure populations is required to identify and treat exposure-related adverse effects.
PMCID:4968872
PMID: 26682920
ISSN: 1942-5546
CID: 1878222

Reply [Letter]

Webber, Mayris P; Berman, Jessica; Qayyum, Basit; Jaber, Nadia; Prezant, David J
PMID: 26138055
ISSN: 2326-5205
CID: 1650072

Nested case-control study of selected systemic autoimmune diseases in world trade center rescue/recovery workers

Webber, M P; Moir, W; Zeig-Owens, R; Glaser, M S; Jaber, N; Hall, C; Berman, J; Qayyum, B; Loupasakis, K; Kelly, K; Prezant, D J
OBJECTIVE: To test the a priori hypothesis that acute and chronic work exposures to the World Trade Center (WTC) site on or after September 11, 2001 were associated with risk of new-onset systemic autoimmune diseases. METHODS: A nested case-control study was performed in WTC rescue/recovery workers who had received a rheumatologist-confirmed systemic autoimmune disease diagnosis between September 12, 2001 and September 11, 2013 (n = 59), each of whom was individually matched to 4 randomly selected controls (n = 236) on the basis of year of hire (+/-1 year), sex, race, and work assignment (firefighter or emergency medical service). Acute exposure was defined according to the earliest time of arrival (morning of 9/11 versus later) at the WTC site, and chronic exposure was defined as duration (number of months) of WTC site-related work. Rheumatologists were blinded with regard to each subject's exposure status. The conditional odds ratios (CORs) with 95% confidence intervals (95% CIs) for incident autoimmune disease were derived from exact conditional logistic regression models. RESULTS: Rheumatoid arthritis was the most common autoimmune diagnosis (37% of subjects), followed by spondyloarthritis (22%), inflammatory myositis (14%), systemic lupus erythematosus (12%), systemic sclerosis (5%), Sjogren's syndrome (5%), antiphospholipid syndrome (3%), and granulomatosis with polyangiitis (Wegener's) (2%). The COR for incident autoimmune disease increased by 13% (COR 1.13, 95% CI 1.02-1.26) for each additional month worked at the WTC site. These odds were independent of the association between high acute exposure (working during the morning of 9/11) and disease outcome, which conveyed an elevated, but not statistically significant, risk (COR 1.85, 95% CI 0.86-3.89). CONCLUSION: Prolonged work at the WTC site, independent of acute exposure, was an important predictor of post-9/11 systemic autoimmune diseases. The WTC Health Program should expand surveillance efforts for those with extended exposures, as early detection can facilitate early treatment, which has been shown to minimize organ damage and improve quality of life.
PMCID:5562156
PMID: 25779102
ISSN: 2326-5205
CID: 1579802

Refractory sarcoid arthritis in world trade center-exposed new york city firefighters: a case series

Loupasakis, Konstantinos; Berman, Jessica; Jaber, Nadia; Zeig-Owens, Rachel; Webber, Mayris P; Glaser, Michelle S; Moir, William; Qayyum, Basit; Weiden, Michael D; Nolan, Anna; Aldrich, Thomas K; Kelly, Kerry J; Prezant, David J
OBJECTIVE: The objective of this study was to describe cases of sarcoid arthritis in firefighters from the Fire Department of the City of New York (FDNY) who worked at the World Trade Center (WTC) site. METHODS: All WTC-exposed FDNY firefighters with sarcoidosis and related chronic inflammatory arthritis (n = 11) are followed jointly by the FDNY-WTC Health Program and the Rheumatology Division at the Hospital for Special Surgery. Diagnoses of sarcoidosis were based on clinical, radiographic, and pathological criteria. Patient characteristics, WTC exposure information, smoking status, date of diagnosis, and pulmonary findings were obtained from FDNY-WTC database. Joint manifestations (symptoms and duration, distribution of joints involved), radiographic findings, and treatment responses were obtained from chart review. RESULTS: Nine of 60 FDNY firefighters who developed sarcoidosis since 9/11/2001 presented with polyarticular arthritis. Two others diagnosed pre-9/11/2001 developed sarcoid arthritis after WTC exposure. All 11 were never cigarette smokers, and all performed rescue/recovery at the WTC site within 3 days of the attacks. All had biopsy-proven pulmonary sarcoidosis, and all required additional disease-modifying antirheumatic drugs for adequate control (stepwise progression from hydroxychloroquine to methotrexate to anti-tumor necrosis factor alpha agents) of their joint manifestations. CONCLUSIONS: Chronic inflammatory polyarthritis appears to be an important manifestation of sarcoidosis in FDNY firefighters with sarcoidosis and WTC exposure. Their arthritis is chronic and, unlike arthritis in non-WTC-exposed sarcoid patients, inadequately responsive to conventional oral disease-modifying antirheumatic drugs, often requiring anti-tumor necrosis factor alpha agents. Further studies are needed to determine the generalizability of these findings to other groups with varying levels of WTC exposure or with other occupational/environmental exposures.
PMCID:4714559
PMID: 25539429
ISSN: 1076-1608
CID: 1419602

Inflamamatory Myositis-Increased Incidence In Fire Department Of New York Firefighters After World Trade Center Exposure [Meeting Abstract]

Qayyum, Basit ; Glaser, Michelle S. ; Jaber, Nadia ; Zeig-Owens, Rachel ; Webber, Mayris P. ; Nolan, Anna ; Kelly, Kerry J. ; Prezant, David J.
ISI:000325359204474
ISSN: 0004-3591
CID: 656602

Case of late diagnosis of Gaucher disease in an elderly female [Meeting Abstract]

Qayyum, B; Moazen, L; Freedman, M
ISI:000228450900055
ISSN: 0002-8614
CID: 56251

Survival in the long term of elderly patients following PEG placement [Meeting Abstract]

Sedlackova, M; Sansone, GR; Qayyum, B; Moazen, L; Frengley, J
ISI:000220899100278
ISSN: 0002-8614
CID: 46636