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Sarcoidosis, polyarthritis prevalent in FDNY firefighters after WTC exposure
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Sarcoidosis and polyarthritis were found to be prevalent in firefighters from New York City who worked at the World Trade Center after Sept. 11, 2001, and were more responsive to treatment with tumor necrosis factor inhibitors, according to recently published data.
Researchers reviewed patient characteristics, World Trade Center (WTC) exposure information, smoking status, date of diagnosis and pulmonary findings obtained from the New York City firefighters (FDNY)-WTC database for all WTC-exposed FDNY firefighters with confirmed sarcoidosis and related chronic inflammatory arthritis. Additionally, patients’ charts were reviewed for joint manifestations, radiographic findings and treatment responses.
Of 13,468 FDNY firefighters present at the WTC site, 60 were diagnosed with biopsy-confirmed sarcoidosis between Sept. 11, 2001, and Dec. 31, 2013, with nine who also presented with polyarticular arthritis. Two others diagnosed prior to Sept. 11 developed sarcoid arthritis after WTC exposure. Median patient age at onset of disease was 44 years. None of the patients had ever been cigarette smokers, and all had participated in the rescue and recovery efforts within 3 days after the attacks, according to the researchers.
Based on chest radiographs, three presented with stage-one pulmonary sarcoidosis, seven were stage at two and one was at stage four; none presented on radiograph with pulmonary sarcoidosis prior to employment.
Polyarthritis was symmetrical in all 11 patients, with swelling and painful stiffness of small joints in 10 patients, in the ankles for nine patients and in the wrists for seven. In five patients, both small and large joints were affected.
Patients were tested for serum biomarkers of autoimmune diseases. Four of 10 who were tested showed elevated angiotensin-converting enzyme levels. Nine of 10 had normal sedimentation rates, and only one had elevated C-reactive protein. Eleven were negative for anti-citrullinated peptide antibodies, and one had low positive rheumatoid factor.
Patients were treated with disease-modifying anti-rheumatic drugs, 10 of whom were treated with hydroxychloroquine for at least 3 to 4 months; eight of the 10 also received corticosteroids.
Anti- tumor necrosis factor (TNF) agents were eventually started in eight patients who failed prior treatment, and most responded with 70% improvement of better; however, one discontinued treatment due to concern about immunosuppression. The remaining seven continued for at least 1 year with anti-TNF therapy, according to the researchers. – by Shirley Pulawski
Disclosures: The authors report no relevant financial disclosures.
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