title: Autoimmunity of the lung and oral mucosa in a multisystem inflammatory disease: The spark that lights the fire in rheumatoid arthritis?
abstract: There is a growing body of evidence to suggest that autoimmunity in patients with rheumatoid arthritis (RA) is initiated outside the joint. This is supported by the observation that circulating autoantibodies, including both rheumatoid factor and anti-citrullinated protein antibody, can be detected in many subjects years before the development of initial joint symptoms leading to an RA diagnosis. Of the potential extra-articular sites implicated in disease initiation, mucosal tissues have garnered increasing attention. Several lines of investigation have separately implicated mucosal tissues from varying anatomic locations as possible initiating sites for RA, including those from the lung and oral cavity. In this review we summarize recent reports incriminating these mucosal tissues as the initial site of autoantibody generation and inflammation in patients with RA.
authors.affiliation: Division of Rheumatology, Department of Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, Neb; Veterans Affairs (VA) Nebraska-Western Iowa Health Care System, Omaha, Neb. Electronic address: tmikuls@unmc.edu.
authors.forename: Ted R
authors.initials: TR
authors.lastname: Mikuls
authors.affiliation: Division of Rheumatology, Department of Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, Neb; Division of Periodontics, Department of Surgical Specialties, College of Dentistry, University of Nebraska Medical Center, Lincoln, Neb.
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Payne
authors.affiliation: Division of Rheumatology, Department of Medicine, University of Colorado, Aurora, Colo.
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Deane
authors.affiliation: Division of Rheumatology, Department of Medicine, College of Medicine, University of Nebraska Medical Center, Omaha, Neb; Veterans Affairs (VA) Nebraska-Western Iowa Health Care System, Omaha, Neb.
authors.forename: Geoffrey M
authors.initials: GM
authors.lastname: Thiele
mesh_terms: D000818:Animals; D001172:Arthritis, Rheumatoid / Q000276:immunology*; D015551:Autoimmunity; D006801:Humans; D007249:Inflammation / Q000276:immunology; D009061:Mouth Mucosa / Q000276:immunology*; D020545:Respiratory Mucosa / Q000276:immunology*
keywords: Rheumatoid arthritis; anti-citrullinated protein antibody; autoantibody; mucosal inflammation; rheumatoid factor