Refractory sarcoid arthritis in world trade center-exposed New York City firefighters: A case series

Konstantinos Loupasakis, Jessica Berman, Nadia Jaber, Rachel Zeig-Owens, Mayris P. Webber, Michelle S. Glaser, William Moir, Basit Qayyum, Michael D. Weiden, Anna Nolan, Thomas K. Aldrich, Kerry J. Kelly, David J. Prezant

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

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 α 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 α 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.

Original languageEnglish (US)
Pages (from-to)19-23
Number of pages5
JournalJournal of Clinical Rheumatology
Volume21
Issue number1
DOIs
StatePublished - Jan 13 2015

Fingerprint

Firefighters
Arthritis
Sarcoidosis
Antirheumatic Agents
Joints
Mouth Diseases
Tumor Necrosis Factor-alpha
Special Hospital
Hydroxychloroquine
Pulmonary Sarcoidosis
Information Centers
Drug and Narcotic Control
Environmental Exposure
Rheumatology
Occupational Exposure
Methotrexate
Tobacco Products
Smoking
Databases
Biopsy

Keywords

  • environmental factors
  • firefighters
  • polyarthritis
  • sarcoidosis
  • World Trade Center

ASJC Scopus subject areas

  • Rheumatology

Cite this

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.

In: Journal of Clinical Rheumatology, Vol. 21, No. 1, 13.01.2015, p. 19-23.

Research output: Contribution to journalArticle

Loupasakis, K, Berman, J, Jaber, N, Zeig-Owens, R, Webber, MP, Glaser, MS, Moir, W, Qayyum, B, Weiden, MD, Nolan, A, Aldrich, TK, Kelly, KJ & Prezant, DJ 2015, 'Refractory sarcoid arthritis in world trade center-exposed New York City firefighters: A case series', Journal of Clinical Rheumatology, vol. 21, no. 1, pp. 19-23. https://doi.org/10.1097/RHU.0000000000000185
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. / Refractory sarcoid arthritis in world trade center-exposed New York City firefighters : A case series. In: Journal of Clinical Rheumatology. 2015 ; Vol. 21, No. 1. pp. 19-23.
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