Clinical Evaluation of Sarcoidosis in Community Members with World Trade Center Dust Exposure

Abstract

Background: Sarcoidosis is a granulomatous disease involving intrathoracic and extrathoracic organs. Genetic and environmental factors, such as exposure to World-Trade Center (WTC) dust after 9/11, may play a role in clinical presentation. Characterization of sarcoidosis in community members with exposure to the WTC dust can provide further insight into the relationship between environmental exposure and sarcoidosis. Methods: Patients with documented sarcoidosis were identified in the WTC Environmental Health Center (EHC), a treatment program for community members. Demographic and clinical data were collected from standardized questionnaires and chart review. Organ involvement was assessed with a standard instrument. Results: Among patients in the WTC EHC, 87 were identified with sarcoidosis after 9/11. Sarcoidosis cases were more likely African-American, local workers, and had more respiratory symptoms, compared with non-sarcoidosis WTC EHC patients. Many (46%) had ≥ Scadding stage 3 on chest imaging, and had reduced lung function measures. Extrathoracic involvement was identified in 33/87 (38%) with a diversity of organs involved. Conclusions: WTC-exposed sarcoidosis in community members is often characterized by severe pulmonary disease and a high rate of diverse extrathoracic involvement. Further analysis is required to characterize the course of disease progression or resolution.

Lung Cancer Characteristics in the World Trade Center Environmental Health Center

“…We, as well as other researchers, demonstrated that WTC acute and chronic exposures are significantly associated with many adverse health conditions in adults and children, particularly aerodigestive disorders [2,[6][7][8][9][10][11][12][13][14][15]. Increased cancer rates (e.g., thyroid cancer, prostate cancer) and decreased rates for lung cancer have been described in the WTC Responders and WTC Survivors [16][17][18][19][20], with numerous cancers included in the list of WTC-related diseases in 2012 [5].…”

The Development of a WTC Environmental Health Center Pan-Cancer Database

“…Detailed information is captured on type, onset and severity of numerous physical symptoms. We previously used the WTC EHC clinical database to conduct and publish research on lower respiratory symptoms (LRS) and neuropathic symptoms [ 4 , 14 , 15 , 16 , 17 , 18 , 36 ]. In addition to exposures to WTC dust and fume, the WTC survivors were also exposed to traumatic psychological exposures, and extensive data have been collected on mental health symptoms of PTSD, depression, anxiety and substance use [ 19 ].…”

“…The WTCHP created inclusion criteria for enrollment for treatment in this program, which required defined WTC exposures, and for community members only, the presence of a certifiable WTC-related health condition [ 4 ]. We previously showed that WTC acute and chronic exposures are significantly associated with lower respiratory symptoms (LRS), lung function abnormalities and neuropathic symptoms [ 14 , 15 , 16 , 17 , 18 ]. Moreover, our documentation of psychological exposures and relevant mental health symptoms (PTSD, anxiety and depression) allowed longitudinal mental health analysis and we showed that WTC dust exposures are associated with mental health disorders [ 19 , 20 ] as well as physical health symptoms of WTC survivors, including both adults and children [ 4 , 5 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ].…”

Editorial for “Long-Term Health Effects of the 9/11 Disaster” in International Journal of Environmental Research and Public Health, 2019

“…Three other papers reported additional findings on a condition known as sarcoidosis (Cleven, 2019 [11]; Hena, 2019 [12]) and sarcoid-like granulomatous (Sunil, 2019). Sarcoidosis is a rare autoimmune disease that can affect any organ, but among rescue, recovery, clean-up workers, it has been previously reported as granulomatous disease involving the thoracic organs (Izbicki, 2007 [13]; Jordan, 2011 [14]), primarily among firefighters or other rescue, recovery, or clean-up workers arriving early at the WTC site.…”

“…Sarcoidosis is a rare autoimmune disease that can affect any organ, but among rescue, recovery, clean-up workers, it has been previously reported as granulomatous disease involving the thoracic organs (Izbicki, 2007 [13]; Jordan, 2011 [14]), primarily among firefighters or other rescue, recovery, or clean-up workers arriving early at the WTC site. One paper in this issue describes sarcoidosis among community members who were patients at the WTC Environmental Health Center (Hena, 2019 [12]). Another paper focused on the genetic predisposition for sarcoidosis in a case control study (Cleven, 2019 [11]).…”