9/11 responders: intense dust exposure linked to systemic autoimmune disease

  • Miller-Archie SA & al.
  • Arthritis Rheumatol
  • 24/11/2019

  • Miriam Davis, PhD
  • Clinical Essentials
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Takeaway

  • An analysis of the World Trade Center Health Registry has found that intense dust exposure among responders is associated with new-onset systemic autoimmune disease (SAID), as is PTSD among community members.

Why this matters

  • Findings implicate components of dust cloud and PTSD in the etiology of SAID.
  • Clinicians treating 9/11 survivors should be alerted to the potential associations.

Study design

  • New-onset SAID (n=2786) was studied in a longitudinal prospective cohort of responders (rescue, recovery, and clean-up response) and community members (people who worked, resided, attended school, or were in transit in Lower Manhattan the morning of the attack) in comparison with people who denied a SAID (n=37,017).
  • SAID was validated by classification criteria, rheumatologist diagnosis, or having been prescribed SAID medication.
  • Funding: CDC; other government agencies.

Key results

  • Among the 118 people with validated SAID, 62 were responders and 56 were community members.
  • 12% of the 118 people had >1 SAID.
  • Most common SAIDs:
    • Rheumatoid arthritis (n=71).
    • Sjögren's syndrome (n=22).
  • Responders with intense dust exposure had nearly double the risk for SAID (adjusted risk ratio [ARR], 1.86; 95% CI, 1.02-3.40).
  • Community members with PTSD had nearly triple the risk for SAID (ARR, 2.80; 95% CI, 1.60-4.90).

Limitations

  • Observational design.
  • Low response rate to Wave 3 questionnaire (63%).