Lung disease with anti-CCP antibodies but not rheumatoid arthritis or connective tissue disease

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• 作者：Aryeh Fischer ; ^{fischera@njhealth.org} ; Joshua J. Solomon ; Roland M. du Bois ; Kevin D. Deane ; Amy L. Olson ; Evans R. Fernandez-Perez ; Tristan J. Huie ; Allen D. Stevens ; Mary B. Gill ; Avi M. Rabinovitch ; David A. Lynch ; David A. Burns ; Isabel S. Pineiro ; Steve D. Groshong ; Rosane D. Duarte Achcar ; Kevin K. Brown ; Richard J. Martin ; Jeffrey J. Swigris
• 关键词：Anti-cyclic citrullinated peptide ; Rheumatoid arthritis ; Interstitial lung disease ; Lung diseases
• 刊名：Respiratory Medicine
• 出版年：2012
• 期刊代码：273_09546111
• 类别：med
• 出版时间：July, 2012
• 卷：106
• 期：7
• 页码：1040-1047
• 文件大小：698 K

摘要

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Summary

Objective

We sought to characterize a novel cohort of patients with lung disease, anti-cyclic citrullinated peptide (CCP) antibody positivity, without rheumatoid arthritis (RA) or other connective tissue disease (CTD).

Methods

The study sample included 74 subjects with respiratory symptoms, evaluated January 2008-January 2010 and found to have a positive anti-CCP antibody but no evidence for RA or other CTD. Each underwent serologic testing, pulmonary physiology testing, and thoracic high-resolution computed tomography (HRCT) scan as part of routine clinical evaluation.

Results

The majority of subjects were women, and most were former cigarette smokers. Four distinct radiographic phenotypes were identified: isolated airways disease (54%), isolated interstitial lung disease (ILD) (14%), mixed airways disease and ILD (26%), and combined pulmonary fibrosis with emphysema (7%). This cohort had a predominance of airways disease, either in isolation or along with a usual interstitial pneumonia-pattern of ILD. Among subjects with high-titer anti-CCP positivity (n = 33), three developed the articular manifestations of RA during a median follow-up of 449 days.

Conclusion

We have described a unique cohort of patients with anti-CCP antibody positivity and lung disease in the absence of existing RA or other CTD. The lung phenotypic characteristics of this cohort resemble those of established RA and a few of these patients have developed articular RA within a short period of follow-up. The implications of a positive anti-CCP antibody among patients with lung disease but not RA are not yet known, but we believe requires further investigation.