December 18, 2019
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9/11 first responders at increased risk for systemic autoimmune disease

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Intense dust cloud inhalation, as well as PTSD, experienced by first responders and community members present at the Sept. 11 terrorist attack in New York are associated with a significant increased risk for systemic autoimmune disease, including rheumatoid arthritis and lupus, according to findings published in Arthritis & Rheumatology.

“We began to explore this topic for a number of reasons,” Sara A. Miller-Archie, MPH, and James E. Cone, MD, MPH, both of the New York City Department of Health and Mental Hygiene, told Healio Rheumatology in an interview. “First, we had been approached by enrollees in the World Trade Center Health Registry (WTCHR) who were concerned about autoimmune diseases in their community. Second, we knew that prior studies had linked components of the 9/11 dust cloud to autoimmune diseases in other populations with different exposures.”

“We also knew of multiple studies that had observed an association between PTSD, which is one of the most common 9/11-associated mental health conditions, to the onset of autoimmune disease,” they added. “Third, researchers at the Fire Department of the City of New York (FDNY) had found that — among their firefighters and EMS personnel who had been part of the 9/11 rescue, recovery, and clean-up effort — those with prolonged work duration or more intense exposure were more likely to develop a post-9/11 systemic autoimmune disease.”

To examine whether dust exposure and PTSD were linked to an increased risk for systemic autoimmune disease among those exposed to the Sept. 11 attack and first responders, Miller-Archie and colleagues polled and reviewed medical data for enrollees of the WTCHR. According to the researchers, the registry is a longitudinal, prospective cohort of 71,426 individuals who were exposed to the Sept. 11 attack or involved in rescue, recovery or clean-up efforts. Enrollment occurred in 2003 to 2004, with subsequent follow-up surveys in 2006 to 2007 and 2011 to 2012.

Intense dust cloud inhalation, as well as PTSD, experienced by first responders and community members present at the Sept. 11 terrorist attack in New York are associated with a significant increased risk for systemic autoimmune disease, including rheumatoid arthritis and lupus, according to findings.

For their study, Miller-Archie and colleagues included all adults who reported on the 2011 to 2012 survey that they had been told by a health professional after 2001 that they had rheumatoid arthritis or another autoimmune disorder. Among the 43,133 enrollees examined, 2,786 self-reported developing a systemic autoimmune disorder since 2001. The researchers were able to secure consent from 1,041 of these individuals to confirm their diagnoses. The 37,017 enrollees who denied having an autoimmune disease were used as control participants.

The researchers used multivariable logbinomial regression to examine the link between multiple Sept. 11 exposures and the risk for postattack systemic autoimmune disorders, stratifying by responders and community members.

According to the researchers, there were 118 enrollees with a confirmed diagnosis of a systemic autoimmune disease. In total, there were 71 patients with rheumatoid arthritis, 22 patients with Sjgren’s syndrome, 20 patients with systemic lupus erythematosus, nine patients with myositis, seven with mixed connective tissue disease and four with scleroderma.

In addition, Sept. 11 first responders with intense dust cloud exposure demonstrated nearly twice the risk for developing a systemic autoimmune disease (aOR = 1.86; 95% CI, 1.02-3.4). Community members who lived or worked in the area of the attack and experienced related PTSD have a nearly threefold increased risk for systemic autoimmune disease.

“Our study was the first one to look at both community members and the broader group rescue/recovery/clean-up workers,” Miller-Archie and Cone said. “Additionally, this study is one of the largest if not the largest study to date of autoimmune diseases following a disaster or other environmental exposure.”

“Among individuals who took part in the rescue, recovery, or clean-up effort after 9/11, those who experienced intense dust cloud exposure that morning had an increased risk of developing a systemic autoimmune disease,” they added. “Community members who developed PTSD after 9/11 were more likely to be diagnosed with a systemic autoimmune disease. Clinicians treating 9/11 survivors should be aware of the potential increased risk of systemic autoimmune disease in this population.” – by Jason Laday

Disclosure : The researchers report relevant financial disclosures.