title: Refractory sarcoid arthritis in World Trade Center-exposed New York City firefighters: a case series.
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.
authors.affiliation: From the *Hospital for Special Surgery/Weill Cornell Medical College; †Department of Medicine, Montefiore Medical Center, Brooklyn; ‡Bureau of Health Services, Fire Department of New York, Brooklyn; §Department of Epidemiology and Population Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx; ║Division of Pulmonary, Critical Care & Sleep Medicine, New York University School of Medicine; and ¶Division of Rheumatology, New York University School of Medicine, NY.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Loupasakis
authors.forename: Jessica
authors.initials: J
authors.lastname: Berman
authors.forename: Nadia
authors.initials: N
authors.lastname: Jaber
authors.forename: Rachel
authors.initials: R
authors.lastname: Zeig-Owens
authors.forename: Mayris P
authors.initials: MP
authors.lastname: Webber
authors.forename: Michelle S
authors.initials: MS
authors.lastname: Glaser
authors.forename: William
authors.initials: W
authors.lastname: Moir
authors.forename: Basit
authors.initials: B
authors.lastname: Qayyum
authors.forename: Michael D
authors.initials: MD
authors.lastname: Weiden
authors.forename: Anna
authors.initials: A
authors.lastname: Nolan
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Aldrich
authors.forename: Kerry J
authors.initials: KJ
authors.lastname: Kelly
authors.forename: David J
authors.initials: DJ
authors.lastname: Prezant
mesh_terms: D000328:Adult; D000465:Algorithms; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001168:Arthritis / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology*; D001688:Biological Products / Q000627:therapeutic use; D004351:Drug Resistance; D061388:Firefighters; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009519:New York City; D016273:Occupational Exposure / Q000009:adverse effects*; D012189:Retrospective Studies; D012507:Sarcoidosis / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology*; D047851:September 11 Terrorist Attacks; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products; D014409:Tumor Necrosis Factor-alpha