Gizinski Alison M, Mascolo Margherita, Loucks Jennifer L, Kervitsky Alma, Meehan Richard T, Brown Kevin K, Holers V Michael, Deane Kevin D
Division of Rheumatology, University of Michigan, Ann Arbor, MI, USA.
Clin Rheumatol. 2009 May;28(5):611-3. doi: 10.1007/s10067-009-1128-9. Epub 2009 Feb 28.
The purpose of this study was to identify rheumatoid arthritis (RA)-related autoantibodies in subjects with interstitial lung disease (ILD) and no articular findings of RA, supporting the hypothesis that RA-related autoimmunity may be generated in non-articular sites, such as the lung. This was a retrospective chart review utilizing clinic databases of patients with ILD to identify cases with lung disease, RA-related autoantibody positivity, and no clinical evidence of articular RA. Four patients with ILD, RF, and anti-CCP positivity and no articular findings of RA were identified. All four patients were male with a mean age at time of diagnosis of ILD of 70 years old. All had a history of smoking. Three patients died within 2 years of diagnosis of ILD and never developed articular symptoms consistent with RA; the final case met full criteria for articular RA several months after stopping immunosuppressive treatment for ILD. RF and anti-CCP can be present in smokers with ILD without clinical evidence of articular RA and in one case symptomatic ILD and autoantibody positivity preceded the development of articular RA. These findings suggest that RA-specific autoimmunity may be generated due to immunologic interactions in the lung and may be related to environmental factors such as smoking.
本研究的目的是在间质性肺疾病（ILD）患者且无类风湿关节炎（RA）关节表现的受试者中识别与RA相关的自身抗体，支持RA相关自身免疫可能在非关节部位（如肺）产生的假说。这是一项回顾性病历审查，利用ILD患者的临床数据库来识别患有肺部疾病、RA相关自身抗体阳性且无关节型RA临床证据的病例。确定了4例患有ILD、类风湿因子（RF）和抗环瓜氨酸肽（CCP）阳性且无RA关节表现的患者。所有4例患者均为男性，诊断ILD时的平均年龄为70岁。均有吸烟史。3例患者在诊断ILD后2年内死亡，从未出现与RA一致的关节症状；最后1例在停止针对ILD的免疫抑制治疗数月后符合关节型RA的全部标准。RF和抗CCP可出现在患有ILD的吸烟者中，且无关节型RA的临床证据，在1例中，有症状的ILD和自身抗体阳性先于关节型RA的出现。这些发现表明，RA特异性自身免疫可能是由于肺部的免疫相互作用产生的，并且可能与吸烟等环境因素有关。
