title: Visual Assessment of Chest Computed Tomography Findings in Anti-cyclic Citrullinated Peptide Antibody Positive Rheumatoid Arthritis: Is it Associated with Airway Abnormalities?
abstract: BACKGROUND
  We aimed to evaluate the association between specific anti-cyclic citrullinated peptide antibody (ACCPA) and pulmonary abnormalities in rheumatoid arthritis (RA) subjects.
  
  
  METHODS
  Computed tomography (CT) images of 83 subjects with RA were evaluated in a blind fashion. Enrolled subjects underwent autoantibody testing to determinate titer of ACCPA and rheumatoid factor, and pulmonary function testing. Visual CT assessment included lobar analysis for extent of semi-quantitative total interstitial lung disease score (ILDS) and each airway abnormality score (bronchiectasis, bronchial wall thickening, centrilobular nodules, and expiratory air trapping). Correlation tests, and simple and multiple regression analyses were performed to determine the relationship between the visual CT abnormalities, physiologic parameters, and autoantibody titers.
  
  
  RESULTS
  ACCPA-positive subjects had a greater extent and higher prevalence of small airway abnormalities including centrilobular nodules and air trapping compared to ACCPA-negative subjects (all p < 0.05). Bronchiectasis and bronchial wall thickening correlated with the ratio of forced expiratory volume in 1 s and forced vital capacity (FVC) (r = -0.236 and r = -0.329, all p < 0.05), and ILDS correlated with FVC and the diffusing capacity of the lung for carbon monoxide (r = -0.218 and r = -0.366, all p < 0.05). Bronchial wall thickening and air trapping correlated with ACCPA titers (r = 0.235 and r = 0.264, all p < 0.05). Air trapping and bronchial wall thickening were significantly associated with ACCPA titers.
  
  
  CONCLUSIONS
  In ACCPA (+) RA, visual CT assessment of large and small airways beyond RA-ILD, which is attributable to RA-related autoimmunity, can provide valuable information regarding airway abnormalities, regardless of the patients' physiologic airflow limitations.
authors.affiliation: Department of Radiology, Chungnam National University Hospital, Chungnam National University School of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon, 301-721, Republic of Korea.
authors.forename: Won Hong
authors.initials: WH
authors.lastname: Park
authors.affiliation: Department of Radiology, Chungnam National University Hospital, Chungnam National University School of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon, 301-721, Republic of Korea. haneul88@hanmail.net.
authors.forename: Song Soo
authors.initials: SS
authors.lastname: Kim
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea.
authors.forename: Seung Cheol
authors.initials: SC
authors.lastname: Shim
authors.affiliation: Division of Rheumatology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea.
authors.forename: Seung Taek
authors.initials: ST
authors.lastname: Song
authors.affiliation: Division of Pulmonology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea.
authors.forename: Sung Soo
authors.initials: SS
authors.lastname: Jung
authors.affiliation: Department of Radiology, Chungnam National University Hospital, Chungnam National University School of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon, 301-721, Republic of Korea.
authors.forename: Jin Hwan
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Convergence Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Namkug
authors.initials: N
authors.lastname: Kim
authors.affiliation: Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Joon Beom
authors.initials: JB
authors.lastname: Seo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000097:blood* / Q000150:complications; D001323:Autoantibodies / Q000097:blood*; D001987:Bronchiectasis / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D017563:Lung Diseases, Interstitial / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D055613:Multiple Pulmonary Nodules / Q000150:complications / Q000000981:diagnostic imaging*; D010456:Peptides, Cyclic / Q000276:immunology*; D011653:Pulmonary Diffusing Capacity; D012217:Rheumatoid Factor / Q000097:blood; D016037:Single-Blind Method; D014056:Tomography, X-Ray; D014797:Vital Capacity; D055815:Young Adult
chemical_list: D001323:Autoantibodies; D010456:Peptides, Cyclic; C487763:cyclic citrullinated peptide; D012217:Rheumatoid Factor
keywords: Airway remodeling; Autoantibodies; Computed tomography; Lung diseases; Rheumatoid arthritis