The lung in ACPA-positive rheumatoid arthritis: an initiating site of injury?
Recent findings have highlighted the potential initiation of ACPA in sites away from the joint. Periodontitis is an example of this concept. This process in the gums appears to be independent of smoking, the main environmental risk factor for ACPA-positive RA. There is extensive literature regarding the potential role of smoking in the pathogenesis of ACPA-positive RA. As a consequence of this strong association, the lung has become the focus of research to determine whether processes within the lung are linked to the generation of ACPA. Here we outline the current body of evidence and explore the hypothesis that the lung as an organ of immune defence has a role in the pathogenesis of the autoimmune disease ACPA-positive RA.
Department of Rheumatology, Queen Elizabeth Hospital, Gateshead, Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK, Department of Biochemistry, University of Alberta, Edmonton, Canada, Lung Immunobiology and Transplantation Group, Institute of Cellular Medicine, Newcastle University, Sir William Leech Centre, Freeman Hospital, Newcastle and Department of Rheumatology, Royal Cornwall Hospital, Truro, UK. Department of Rheumatology, Queen Elizabeth Hospital, Gateshead, Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK, Department of Biochemistry, University of Alberta, Edmonton, Canada, Lung Immunobiology and Transplantation Group, Institute of Cellular Medicine, Newcastle University, Sir William Leech Centre, Freeman Hospital, Newcastle and Department of Rheumatology, Royal Cornwall Hospital, Truro, UK. e.perry@nhs.net.
Elizabeth
E
Perry
Department of Rheumatology, Queen Elizabeth Hospital, Gateshead, Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK, Department of Biochemistry, University of Alberta, Edmonton, Canada, Lung Immunobiology and Transplantation Group, Institute of Cellular Medicine, Newcastle University, Sir William Leech Centre, Freeman Hospital, Newcastle and Department of Rheumatology, Royal Cornwall Hospital, Truro, UK.
Clive
C
Kelly
Department of Rheumatology, Queen Elizabeth Hospital, Gateshead, Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK, Department of Biochemistry, University of Alberta, Edmonton, Canada, Lung Immunobiology and Transplantation Group, Institute of Cellular Medicine, Newcastle University, Sir William Leech Centre, Freeman Hospital, Newcastle and Department of Rheumatology, Royal Cornwall Hospital, Truro, UK. Department of Rheumatology, Queen Elizabeth Hospital, Gateshead, Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK, Department of Biochemistry, University of Alberta, Edmonton, Canada, Lung Immunobiology and Transplantation Group, Institute of Cellular Medicine, Newcastle University, Sir William Leech Centre, Freeman Hospital, Newcastle and Department of Rheumatology, Royal Cornwall Hospital, Truro, UK.
Paul
P
Eggleton
Department of Rheumatology, Queen Elizabeth Hospital, Gateshead, Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK, Department of Biochemistry, University of Alberta, Edmonton, Canada, Lung Immunobiology and Transplantation Group, Institute of Cellular Medicine, Newcastle University, Sir William Leech Centre, Freeman Hospital, Newcastle and Department of Rheumatology, Royal Cornwall Hospital, Truro, UK. Department of Rheumatology, Queen Elizabeth Hospital, Gateshead, Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK, Department of Biochemistry, University of Alberta, Edmonton, Canada, Lung Immunobiology and Transplantation Group, Institute of Cellular Medicine, Newcastle University, Sir William Leech Centre, Freeman Hospital, Newcastle and Department of Rheumatology, Royal Cornwall Hospital, Truro, UK.
Anthony
A
De Soyza
Department of Rheumatology, Queen Elizabeth Hospital, Gateshead, Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK, Department of Biochemistry, University of Alberta, Edmonton, Canada, Lung Immunobiology and Transplantation Group, Institute of Cellular Medicine, Newcastle University, Sir William Leech Centre, Freeman Hospital, Newcastle and Department of Rheumatology, Royal Cornwall Hospital, Truro, UK.
David
D
Hutchinson
D001172:Arthritis, Rheumatoid / Q000150:complications / Q000276:immunology / Q000378:metabolism; D001323:Autoantibodies / Q000276:immunology*; D015551:Autoimmunity; D006801:Humans; D017563:Lung Diseases, Interstitial / Q000209:etiology / Q000276:immunology / Q000378:metabolism; D010456:Peptides, Cyclic / Q000276:immunology* / Q000378:metabolism
D001323:Autoantibodies; D010456:Peptides, Cyclic; C487763:cyclic citrullinated peptide
anti-citrullinated protein/peptide antibodies; autoimmunity; bronchiectasis; cigarette smoking; infection; interstitial lung disease; pathogenesis; rheumatoid arthritis; rheumatoid factor