Anti-carbamylated proteins antibody repertoire in rheumatoid arthritis: evidence of a new autoantibody linked to interstitial lung disease

ObjectiveTo analyse the association between anti-carbamylated protein antibodies (Anti-CarP) and interstitial lung disease (ILD) in rheumatoid arthritis (RA) patients.MethodsCross-sectional study including RA patients fulfilling the 2010 ACR/EULAR criteria. The main population comprised two groups: (1) RA patients diagnosed with RA-ILD (RA-ILD group); (2) RA patients without ILD (non-ILD RA group). Non-ILD RA patients in whom ILD was suspected underwent a diagnostic work-up and, if ILD was diagnosed, were switched to the RA-ILD group. ILD was diagnosed by high-resolution computed tomography and confirmed by a multidisciplinary committee. An independent replication sample was also obtained. Three Anti-CarP IgG autoantibodies against fetal calf serum (Anti-FCS), fibrinogen (Anti-Fib) and chimeric fibrine/filagrine homocitrullinated peptide (Anti-CFFHP) and one Anti-CarP IgA against FCS (Anti-FCS-IgA) were determined by home-made ELISA. Associations between Anti-CarP and ILD were analysed using multivariable logistic regression adjusted by smoking, sex, age, RA disease duration, rheumatoid factor and anticitrullinated protein antibodies.ResultsWe enrolled 179 patients: 37 (21%) were finally diagnosed with RA-ILD. Anti-CarP specificities were more frequent in RA-ILD patients (Anti-FCS 70% vs 43%; Anti-Fib 73% vs 51%; Anti-CFFHP 38% vs 19%; Anti-CarP-IgA 51% vs 20%, p<0.05 for all comparisons). Serum titers of Anti-CarP were significantly higher in RA-ILD patients. Anti-CarP specificities showed a robust effect towards increasing the odds of ILD in the multivariate analysis (Anti-FCS (OR: 3.42; 95% CI: 1.13 to 10.40), Anti-Fib (OR: 2.85; 95% CI: 0.83 to 9.70), Anti-CFFHP (OR: 3.11; 95% CI: 1.06 to 9.14) and Anti-FCS-IgA (OR: 4.30; 95% CI: 1.41 to 13.04)). Similar findings were observed in the replication sample.ConclusionsAnti-CarP were strongly associated with ILD. The role of homocitrullination in RA-ILD merits further investigation.

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Diagnostic delay of associated interstitial lung disease increases mortality in rheumatoid arthritis

Scientific Reports ◽

10.1038/s41598-021-88734-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Esteban Cano-Jiménez ◽

Tomás Vázquez Rodríguez ◽

Irene Martín-Robles ◽

Diego Castillo Villegas ◽

Javier Juan García ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Interstitial Lung Disease ◽

Lung Disease ◽

Independent Predictor ◽

Diagnostic Delay ◽

Cross Sectional Study ◽

Systemic Autoimmune Disease ◽

Cross Sectional ◽

Evolution Characteristics ◽

Cox Analysis

AbstractRheumatoid arthritis (RA) is a systemic autoimmune disease whose main extra-articular organ affected is the lung, sometimes in the form of diffuse interstitial lung disease (ILD) and conditions the prognosis. A multicenter, observational, descriptive and cross-sectional study of consecutive patients diagnosed with RA-ILD. Demographic, analytical, respiratory functional and evolution characteristics were analyzed to evaluate the predictors of progression and mortality. 106 patients were included. The multivariate analysis showed that the diagnostic delay was an independent predictor of mortality (HR 1.11, CI 1.01–1.23, p = 0.035). Also, age (HR 1.33, 95% CI 1.09–1.62, p = 0.0045), DLCO (%) (HR 0.85, 95% CI 0.73–0.98, p = 0.0246), and final SatO2 (%) in the 6MWT (HR 0.62, 95% CI 0.39–0.99, p = 0.0465) were independent predictor variables of mortality, as well as GAP index (HR 4.65, 95% CI 1.59–13.54, p = 0.0051) and CPI index (HR 1.12, 95% CI 1.03–1.22, p = 0.0092). The withdrawal of MTX or LFN after ILD diagnosis was associated with disease progression in the COX analysis (HR 2.18, 95% CI 1.14–4.18, p = 0.019). This is the first study that highlights the diagnostic delay in RA-ILD is associated with an increased mortality just like happens in IPF.

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A Cross-Sectional Study of Radiological Profile of Interstitial Lung Disease Using High Resolution Computed Tomography of Patients Attending Medical College at Ahmedabad

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/218 ◽

2021 ◽

Vol 8 (17) ◽

pp. 1127-1132

Author(s):

Nikunj C. Desai ◽

Nilesh P. Parkar ◽

Asutosh N. Dave

Keyword(s):

Computed Tomography ◽

High Resolution ◽

Interstitial Lung Disease ◽

Lung Disease ◽

Interstitial Pneumonia ◽

Usual Interstitial Pneumonia ◽

Cross Sectional Study ◽

High Resolution Computed Tomography ◽

Cross Sectional ◽

Acute Interstitial Pneumonia

BACKGROUND Interstitial lung disease (ILD) is an unpredictable diffuse parenchymal lung disease, which involves interstitium of lung (tissue around the alveoli of the lungs). High resolution computed tomography (HRCT) is one of the confirmatory, easily accessible methodology for the conclusion and follow up assessment of interstitial lung disease. We wanted to study the normal HRCT patterns found with interstitial lung disease and contrastingly different HRCT designs and clinical information in differential determination of pulmonary fibrosis. We also wanted to study the different patterns of interstitial lung disease on high resolution computed tomography and thereby provide accurate diagnosis and management to the patients. METHODS The study was a hospital based prospective, cross sectional study. In the present study, total fifty patients referred from Department of Medicine and Department of Pulmonary Medicine of GCS Medical College having suspicion of interstitial lung disease were studied from April 2019 to September 2019. All patients underwent HRCT thorax on 16 slice Siemens computerised tomography (CT) scan machine in recumbent position utilising usual HRCT protocol. Lung abnormalities were noticed and classified for explicit diagnosis of interstitial lung pathologies. RESULTS Most of the patients (N = 25) were found to be in the age group of 50 - 80 years (17 female & 8 male). Progressive dyspnoea (N = 47; 94 %) was the most common chief complaint. The most common form of interstitial lung disease was usual interstitial pneumonia (UIN) (N = 18; 36 %) in our study. Acute interstitial pneumonia (AIP) (N = 7; 14 %) and non-specific interstitial pneumonia, NSIP (N = 7; 14 %) were the next common interstitial lung diseases. CONCLUSIONS The most well-known interstitial lung disease seen in our examination was usual interstitial pneumonia. Cases of interstitial lung disease are on the rise. Interstitial lung disease should be ruled out in all patients with progressive dyspnoea, particularly when there are no obvious or known causes of dyspnoea. Clinical and laboratory findings, pulmonary function tests, history of exposure along with HRCT workup is indispensable for the identification or exclusion of interstitial lung disease. HRCT is also useful for the follow-up study. KEYWORDS Acute Interstitial Pneumonia (AIP), High Resolution Computed Tomography (HRCT), Interstitial Lung Disease (ILD), Nonspecific Interstitial Pneumonia (NSIP), Usual Interstitial Pneumonia (UIP)

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Diagnostic delay of associated interstitial lung disease increases mortality in rheumatoid arthritis: Spanish RA-ILD cohort

10.21203/rs.3.rs-125763/v1 ◽

2020 ◽

Author(s):

Esteban Cano-Jiménez ◽

Tomás Vázquez Rodríguez ◽

Irene Martín-Robles ◽

Diego Castillo Villegas ◽

Javier Juan García ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Interstitial Lung Disease ◽

Lung Disease ◽

Independent Predictor ◽

Diagnostic Delay ◽

Cross Sectional Study ◽

Systemic Autoimmune Disease ◽

Cross Sectional ◽

Evolution Characteristics ◽

Cox Analysis

Abstract Introduction: Rheumatoid arthritis (RA) is a systemic autoimmune disease whose main extra-articular organ affected is the lung, sometimes in the form of diffuse interstitial lung disease (ILD) and conditions the prognosis. Methods: A multicenter, observational, descriptive and cross-sectional study of consecutive patients diagnosed with RA-ILD between 2013 and 2018. Demographic, analytical, respiratory functional and evolution characteristics were analyzed to evaluate the predictors of progression and mortality. Results: 106 patients were included. The mean age was 70.2±19.8 years and 51.9% of the patients presented UIP pattern. In the multivariate Cox analysis the age (HR 1.33, 95% CI 1.09-1.62, p=0.0045), the DLCO (%) (HR 0.85, 95% CI 0.73-0.98, p=0.0246), and the final SatO2 (%) in the 6MWT (HR 0.62, 95% CI 0.39-0.99, p=0.0465) were independent predictor variables of mortality, as well as the GAP index (HR 4.65, 95% CI 1.59 - 13.54, p=0.0051) and the CPI index (HR 1.12, 95% CI 1.03 - 1.22, p=0.0092). Also highlight that the diagnostic delay was an independent predictor of mortality (HR 1.11, CI 1.01-1.23, p = 0.035). Conclusions: This is the first study where it is objectified that the diagnostic delay in RA-ILD is associated with an increased mortality just like happens in IPF.

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A STUDY OF INTERSTITIAL LUNG DISEASE ASSOCIATED WITH RHEUMATOID ARTHRITIS

10.36106/ijsr/3534339 ◽

2021 ◽

pp. 1-2

Author(s):

R.Belinda Anet ◽

Jai Kishan ◽

Sameer Singhal

Keyword(s):

Rheumatoid Arthritis ◽

Interstitial Lung Disease ◽

Lung Disease ◽

Pulmonary Function Tests ◽

Systemic Disease ◽

Cross Sectional Study ◽

Cross Sectional ◽

Radiological Patterns ◽

Laboratory Profile ◽

Restrictive Pattern

BACKGROUND: Rheumatoid Arthritis (RA) is a common systemic disease that manifests as inflammatory arthritis of multiple joints and produces a wide variety of extra-articular manifestations. Interstitial Lung Disease (ILD) is one of the important pulmonary manifestation of RA like other Connective Tissue Disease(CTD). However RA-ILD differs from CTD-ILD in terms of histopathology and prognosis. OBJECTIVES: To study the clinical features, laboratory profile, radiological patterns, pulmonary function tests including spirometry and DLCO in patients with RA-ILD. MATERIALS AND METHODS: This study was a cross sectional study carried out in the department of Respiratory Medicine at MMIMSR,Mullana, Haryana. A total of 10 patients were included in the study after verifying inclusion and exclusion criteria. After complete history and investigations details were documented in a proforma. RESULTS: A total of 10 patients comprising of 3 males and 7 females with a mean age of 56.5 years were included. Dry cough (100%) was the most common presenting complaints followed by excertional dyspnoea (80%). Among the 10 patients 8 were smokers. Bilateral basal Velcro creps was the most common feature (70%) followed by clubbing(20%).In HRCT the most common pattern was UIP (typical UIP-10%, probable UIP-70%) followed by Non-IPF pattern (20%). Spirometry showed restrictive pattern in all cases. DLCO was severely reduced in typical UIP pattern. CONCLUSION: HRCT chest is the most sensitive tool for early diagnosis of ILD, while DLCO is most sensitive for monitoring the prognosis. RA-ILD can be prevented and treated at an early state.

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