title: Brief report: airways abnormalities and rheumatoid arthritis-related autoantibodies in subjects without arthritis: early injury or initiating site of autoimmunity?
abstract: OBJECTIVE
  To evaluate the presence of pulmonary abnormalities in rheumatoid arthritis (RA)-related autoantibody-positive subjects without inflammatory arthritis.
  
  
  METHODS
  Forty-two subjects who did not have inflammatory arthritis but were positive for anti-cyclic citrullinated peptide antibodies and/or ≥2 rheumatoid factor isotypes (a profile that is 96% specific for RA), 15 autoantibody-negative controls, and 12 patients with established seropositive early RA (<1-year duration) underwent spirometry and high-resolution computed tomography (HRCT) lung imaging.
  
  
  RESULTS
  The median age of autoantibody-positive subjects was 54 years, 52% were female, and 38% were ever-smokers; these characteristics were not significantly different from those of autoantibody-negative control subjects. No autoantibody-positive subject had inflammatory arthritis based on joint examination. HRCT revealed that 76% of autoantibody-positive subjects had airways abnormalities including bronchial wall thickening, bronchiectasis, centrilobular opacities, and air trapping, compared with 33% of autoantibody-negative controls (P = 0.005). The prevalence and type of lung abnormalities among autoantibody-positive subjects were similar to those among patients with early RA. In 2 autoantibody-positive subjects with airways disease, inflammatory arthritis classifiable as articular RA developed ∼13 months after the lung evaluation.
  
  
  CONCLUSIONS
  Airways abnormalities that are consistent with inflammation are common in autoantibody-positive subjects without inflammatory arthritis and are similar to airways abnormalities seen in patients with early RA. These findings suggest that the lung may be an early site of autoimmune-related injury and potentially a site of generation of RA-related autoimmunity. Further studies are needed to define the mechanistic role of lung inflammation in the development of RA.
authors.affiliation: University of Colorado, Aurora, CO, USA.
authors.forename: M Kristen
authors.initials: MK
authors.lastname: Demoruelle
authors.forename: Michael H
authors.initials: MH
authors.lastname: Weisman
authors.forename: Philip L
authors.initials: PL
authors.lastname: Simonian
authors.forename: David A
authors.initials: DA
authors.lastname: Lynch
authors.forename: Peter B
authors.initials: PB
authors.lastname: Sachs
authors.forename: Isabel F
authors.initials: IF
authors.lastname: Pedraza
authors.forename: Annie R
authors.initials: AR
authors.lastname: Harrington
authors.forename: Jason R
authors.initials: JR
authors.lastname: Kolfenbach
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Striebich
authors.forename: Quyen N
authors.initials: QN
authors.lastname: Pham
authors.forename: Colin D
authors.initials: CD
authors.lastname: Strickland
authors.forename: Brian D
authors.initials: BD
authors.lastname: Petersen
authors.forename: Mark C
authors.initials: MC
authors.lastname: Parish
authors.forename: Lezlie A
authors.initials: LA
authors.lastname: Derber
authors.forename: Jill M
authors.initials: JM
authors.lastname: Norris
authors.forename: V Michael
authors.initials: VM
authors.lastname: Holers
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Deane
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000000981:diagnostic imaging / Q000276:immunology*; D001175:Arthrography; D001323:Autoantibodies / Q000097:blood / Q000276:immunology*; D015551:Autoimmunity / Q000276:immunology*; D001982:Bronchial Diseases / Q000097:blood / Q000276:immunology*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000276:immunology; D007596:Joints / Q000276:immunology; D008171:Lung Diseases / Q000097:blood / Q000276:immunology*; D008297:Male; D008875:Middle Aged
chemical_list: D001323:Autoantibodies