Clinical Course of Sarcoidosis in World Trade Center-Exposed Firefighters

Details

• Personal Author:
  Acuna DS ; Aizer A ; Aldrich TK ; Berman J ; Christodoulou V ; Cleven K ; Diaz K ; Fullam K ; Goldfarb D ; Gritz D ; Hena KM ; Hena Z ; Judson MA ; Kelly K ; Krumerman A ; Maier L ; Moir W ; Nadia Jaber PA-C ; Nolan A ; OrtizV ; Plotycia SM ; Prezant DJ ; Soghier I ; Spevack DM ; Spivack SD ; Webber MP ; Weiden MD ; Yip J ; Zeig-Owens R
• Corporate Authors:
  FDNY Sarcoidosis Clinical Research Group
• Description:
  BACKGROUND: Sarcoidosis is believed to represent a genetically primed, abnormal immune response to an antigen exposure or inflammatory trigger, with both genetic and environmental factors playing a role in disease onset and phenotypic expression. In a population of firefighters with post-World Trade Center (WTC) 9/11/2001 (9/11) sarcoidosis, we have a unique opportunity to describe the clinical course of incident sarcoidosis during the 15 years postexposure and, on average, 8 years following diagnosis. METHODS: Among the WTC-exposed cohort, 74 firefighters with post-9/11 sarcoidosis were identified through medical records review. A total of 59 were enrolled in follow-up studies. For each participant, the World Association of Sarcoidosis and Other Granulomatous Diseases organ assessment tool was used to categorize the sarcoidosis involvement of each organ system at time of diagnosis and at follow-up. RESULTS: The incidence of sarcoidosis post-9/11 was 25 per 100,000. Radiographic resolution of intrathoracic involvement occurred in 24 (45%) subjects. Lung function for nearly all subjects was within normal limits. Extrathoracic involvement increased, most prominently joints (15%) and cardiac (16%) involvement. There was no evidence of calcium dysmetabolism. Few subjects had ocular (5%) or skin (2%) involvement, and none had beryllium sensitization. Most (76%) subjects did not receive any treatment. CONCLUSIONS: Extrathoracic disease was more prevalent in WTC-related sarcoidosis than reported for patients with sarcoidosis without WTC exposure or for other exposure-related granulomatous diseases (beryllium disease and hypersensitivity pneumonitis). Cardiac involvement would have been missed if evaluation stopped after ECG, 48-h recordings, and echocardiogram. Our results also support the need for advanced cardiac screening in asymptomatic patients with strenuous, stressful, public safety occupations, given the potential fatality of a missed diagnosis. [Description provided by NIOSH]
• Subjects:
  Cardiovascular System Diagnosis Emergency Responders Environment Eye Firefighters Immune System Lung Lung Diseases Lymphatic System Occupational Exposure Occupational Health Particulate Matter Respiratory Function Tests Respiratory System Respiratory Tract Diseases Safety Sense Organs September 11 Terrorist Attacks Skin

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• Keywords:
  Airway Obstruction Articulation Author Keywords: Clinical Course Beryllium Cardiac Function Cellular Reactions Clinical Diagnosis Clinical Techniques Emergency-responders Employee-exposure Employee-health Environmental Factors Eyes Fire-fighters Firefighters Gene Expression Genetic Factors Immune Reaction Immune System Long-term-study Lung-disorders Lung-function Lymph Nodes Particulates Pulmonary-function Pulmonary-function-tests Pulmonary-system-disorders Respiratory-system-disorders Sarcoidosis Spirometry Target Organs Throat World Trade Center WTC

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• ISSN:
  0012-3692
• Document Type:
  Text
• Funding:
  Cooperative Agreement ; Contract
• Genre:
  Journal Article
• Place as Subject:
  Massachusetts ; New York ; OSHA Region 1 ; OSHA Region 2
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  114-123
• Volume:
  153
• Issue:
  1
• NIOSHTIC Number:
  nn:20050910
• Citation:
  Chest 2018 Jan; 153(1):114-123
• Contact Point Address:
  David J. Prezant, MD, Fire Department of the City of New York, 9 Metrotech Center, Room 8N-7, Brooklyn, NY 11201
• Email:
  david.prezant@fdny.nyc.gov
• CAS Registry Number:
  Beryllium (CAS RN 7440-41-7)
• Federal Fiscal Year:
  2018
• Performing Organization:
  Albert Einstein College of Medicine, Bronx, New York
• Peer Reviewed:
  True
• Start Date:
  20150701
• Source Full Name:
  Chest
• End Date:
  20170630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:d40776f0ce29ad54a09e4cbe992bcf688d9b2bba90ab0ea534c123dcf35f497559178deee86befdd607b91280b633bd9accac0117252b3063a6d35d6d66175ea
• Download URL:
  https://stacks.cdc.gov/view/cdc/211095/cdc_211095_DS1.pdf
• File Type:
  [PDF - 154.02 KB ]