The data supporting a role for the lungs in the pathogenesis of RA have moved beyond antibody production. A study from Colorado compared the spirometry and lung CT imaging findings in a sample of patients with confirmed RA of less than one year’s duration to a group of ACPA-positive individuals lacking clinical RA. Investigators found similar findings of chronic lung inflammation in both groups.8
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Taking these data one step further, using mass-spectrometry-based proteomics, a Swedish group studied bronchial and synovial biopsy specimens from a small group of patients with RA and found identical citrullinated peptides present in both tissues, providing further support for a link between lungs and joints in RA.9
This all reminds me of another patient I met many years ago who drove down from the woods of northern New Hampshire to be evaluated for what his country doctor called lung arthritis. Upon hearing the term, I chuckled and carefully explained how his doctor was clearly mistaken and confused about RA. Now I realize that I was the one who was confused!
Simon M. Helfgott, MD, is associate professor of medicine in the Division of Rheumatology, Immunology and Allergy at Harvard Medical School in Boston.
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- Demoruelle MK, Weisman MH, Simonian PL, et al. Brief report: Airways abnormalities and rheumatoid arthritis-related autoantibodies in subjects without arthritis: Early injury or initiating site of autoimmunity? Arthritis Rheum. 2012 Jun;64(6):1756–1761.
- Ytterberg AJ, Joshua V, Reynisdottir G, et al. Shared immunological targets in the lungs and joints of patients with rheumatoid arthritis: Identification and validation. Ann Rheum Dis. 2015 Sep;74:1772–1777.