Abstract
The purpose of this study was to identify rheumatoid arthritis (RA)-related autoantibodies in subjects with interstitial lung disease (ILD) and no articular findings of RA, supporting the hypothesis that RA-related autoimmunity may be generated in non-articular sites, such as the lung. This was a retrospective chart review utilizing clinic databases of patients with ILD to identify cases with lung disease, RA-related autoantibody positivity, and no clinical evidence of articular RA. Four patients with ILD, RF, and anti-CCP positivity and no articular findings of RA were identified. All four patients were male with a mean age at time of diagnosis of ILD of 70 years old. All had a history of smoking. Three patients died within 2 years of diagnosis of ILD and never developed articular symptoms consistent with RA; the final case met full criteria for articular RA several months after stopping immunosuppressive treatment for ILD. RF and anti-CCP can be present in smokers with ILD without clinical evidence of articular RA and in one case symptomatic ILD and autoantibody positivity preceded the development of articular RA. These findings suggest that RA-specific autoimmunity may be generated due to immunologic interactions in the lung and may be related to environmental factors such as smoking.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Avouac J, Gossec L, Dougados M (2006) Diagnostic and predictive value of anti-cyclic citrullinated protein antibodies in rheumatoid arthritis: a systematic literature review. Ann Rheum Dis 65(7):845–851
Nielen MM et al (2004) Specific autoantibodies precede the symptoms of rheumatoid arthritis: a study of serial measurements in blood donors. Arthritis Rheum 50(2):380–386
Metafratzi ZM et al (2007) Pulmonary involvement in patients with early rheumatoid arthritis. Scand J Rheumatol 36(5):338–444
Gabbay E et al (1997) Interstitial lung disease in recent onset rheumatoid arthritis. Am J Respir Crit Care Med 156(2 Pt 1):528–535
Oliver JE, Silman AJ (2006) Risk factors for the development of rheumatoid arthritis. Scand J Rheumatol 35(3):169–174
Arnett FC et al (1988) The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31(3):315–324
Elkayam O et al (2007) Auto-antibody profiles in patients with active pulmonary tuberculosis. Int J Tuberc Lung Dis 11(3):306–310
Bowes J, Barton A (2008) Recent advances in the genetics of RA susceptibility. Rheumatology (Oxford) 47(4):399–402
Klareskog L et al (2006) A new model for an etiology of rheumatoid arthritis: smoking may trigger HLA-DR (shared epitope)-restricted immune reactions to autoantigens modified by citrullination. Arthritis Rheum 54(1):38–46
Alexiou I et al (2008) Anti-cyclic citrullinated peptide-2 (CCP2) autoantibodies and extra-articular manifestations in Greek patients with rheumatoid arthritis. Clin Rheumatol 27(4):511–513
Brannan HM et al (1964) Pulmonary disease associated with rheumatoid arthritis. JAMA 189:914–918
Gottlieb AJ et al (1965) Serologic factors in idiopathic diffuse interstitial pulmonary fibrosis. Am J Med 39:405–410
Makrygiannakis D et al (2008) Smoking increases peptidylarginine deiminase 2 enzyme expression in human lungs and increases citrullination in BAL cells. Ann Rheum Dis 67(10):1488–1492
Disclosures
None
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Gizinski, A.M., Mascolo, M., Loucks, J.L. et al. Rheumatoid arthritis (RA)-specific autoantibodies in patients with interstitial lung disease and absence of clinically apparent articular RA. Clin Rheumatol 28, 611–613 (2009). https://doi.org/10.1007/s10067-009-1128-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10067-009-1128-9