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Components of the dust cloud resulting from the collapse of the <jats:styled-content style=\"fixed-case\">WTC<\/jats:styled-content> have been associated with development of a systemic autoimmune disease, as has posttraumatic stress disorder (<jats:styled-content style=\"fixed-case\">PTSD<\/jats:styled-content>). We undertook this study to determine whether dust exposure and <jats:styled-content style=\"fixed-case\">PTSD<\/jats:styled-content> were associated with an increased risk of systemic autoimmune disease in a 9\/11\u2010exposed cohort.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Among 43,133 <jats:styled-content style=\"fixed-case\">WTC<\/jats:styled-content> Health Registry enrollees, 2,786 self\u2010reported having a post\u20109\/11 systemic autoimmune disease. We obtained informed consent to review medical records to validate systemic autoimmune disease diagnoses for 1,041 enrollees. Diagnoses of systemic autoimmune diseases were confirmed by classification criteria, rheumatologist diagnosis, or having been prescribed systemic autoimmune disease medication. Controls were enrollees who denied having an autoimmune disease diagnosis (n = 37,017). We used multivariable log\u2010binomial regression to examine the association between multiple 9\/11 exposures and risk of post\u20109\/11 systemic autoimmune disease, stratifying by responders (rescue, recovery, and clean\u2010up workers) and community members (e.g., residents, area workers).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We identified 118 persons with systemic autoimmune disease. Rheumatoid arthritis was most frequent (n = 71), followed by Sj\u04e7gren's syndrome (n = 22), systemic lupus erythematosus (n = 20), myositis (n = 9), mixed connective tissue disease (n = 7), and scleroderma (n = 4). Among 9\/11 responders, those with intense dust cloud exposure had almost twice the risk of systemic autoimmune disease (adjusted risk ratio 1.86 [95% confidence interval 1.02\u20133.40]). Community members with <jats:styled-content style=\"fixed-case\">PTSD<\/jats:styled-content> had a nearly 3\u2010fold increased risk of systemic autoimmune disease.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Intense dust cloud exposure among responders and <jats:styled-content style=\"fixed-case\">PTSD<\/jats:styled-content> among community members were associated with a statistically significant increased risk of new\u2010onset systemic autoimmune disease. Clinicians treating 9\/11 survivors should be aware of the potential increased risk of systemic autoimmune disease in this population.<\/jats:p><\/jats:sec>","DOI":"10.1002\/art.41175","type":"journal-article","created":{"date-parts":[[2019,11,25]],"date-time":"2019-11-25T01:15:51Z","timestamp":1574644551000},"page":"849-859","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":43,"title":["Systemic Autoimmune Disease Among Adults Exposed to the September 11, 2001 Terrorist Attack"],"prefix":"10.1002","volume":"72","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4389-0029","authenticated-orcid":false,"given":"Sara A.","family":"Miller\u2010Archie","sequence":"first","affiliation":[{"name":"New York City Department of Health and Mental Hygiene  New York New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter M.","family":"Izmirly","sequence":"additional","affiliation":[{"name":"New York University School 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