Berlin, Germany, June 8 2012: A new study presented today at EULAR 2012, the Annual Congress of the European League Against Rheumatism, shows that lung changes in association with anti-citrullinated protein autoantibody (ACPA) status are a primary manifestation of rheumatoid arthritis (RA).
Study findings show that 51% of RA patients (n=105) had identifiable lung changes (as measured by high resolution computer tomography [HRCT]) as compared to 28% of healthy controls (n=43). In addition, ACPA presence – but not smoking status – was associated with HRCT changes. This demonstrates that lung abnormalities are more frequent in RA patients as compared to individuals without RA, but with comparable age, smoking status, gender and geographic area.
Mass spectrometry identified five proteins in the synovium (eight sites in total) and four in the lungs (six sites in total) containing citrullinated residues. Two vimentin derived citrullinated peptides were present in a majority of both synovial and lung biopsies with higher citrullinated/unmodified peptide ratios in the smokers as compared to non-smokers. Additionally, there was a significant increase in expression of both peptydilamino deiminase (PAD) 2 and PAD4 enzymes in the lungs of current smokers, independent of the ACPA status.
"Our finding suggests an active involvement of the lungs in the initiation phase of chronic inflammatory joint disease. Interestingly, these abnormalities were mainly restricted to those RA patients who were positive for ACPA, as well as smokers," said Dr. Anca Catrina, from the Department of Medicine, Karolinska Institute, Sweden and lead study author. "We believe that there is an urgent need for more active screening to identify lung disease in high risk RA patients (especially ACPA positive smokers). Anti-smoking strategies as part of RA treatment programs and further interventional studies are needed in order to mediate the local immune process in the lungs at an early stage."
This study followed 105 RA patients with symptom duration of less than one year at the time of diagnosis and naïve to treatment with disease modifying anti-rheumatic drugs (DMARDs). A second non-RA cohort was matched for age, smoking status and gender.
The study demonstrates that HRCT abnormalities, shared citrullinated epitopes with the joints and local production of ACPA are present in the lungs of patients before the onset of RA, proposing that site-specific extra articular changes might be the initiating event of the specific immune response in ACPA positive RA.
Abstract Number: FRI0101
NOTES TO EDITORS:
For further information on this study, or to request an interview with the study lead, please do not hesitate to contact the EULAR congress Press Office in Hall 6 on the 3rd floor of the Congress Centre during EULAR 2012 or on:
Email: eularpressoffice@cohnwolfe.com
Candice Debleu:
Onsite tel: +44 7894 386 425
About EULAR
- The European League Against Rheumatism (EULAR) is the organisation which represents the patient, health professional and scientific societies of rheumatology of all the European nations
- In line with The European Union of Medical Specialists (UEMS), EULAR defines rheumatology as including rheumatic diseases of the connective tissue, locomotor and musculoskeletal systems
- EULAR aims to promote, stimulate and support the research, prevention, treatment and rehabilitation of rheumatic diseases. With 45 scientific member societies, 36 PARE organisations and 10 health professionals associations, EULAR underscores the importance of combating rheumatic diseases not only by medical means, but also through a wider context of care for rheumatic patients and a thorough understanding of their social and other needs
- Diseases of the bone and joints such as rheumatoid arthritis and osteoarthritis cause disability in 4-5% of the adult population and are predicted to rise as people live longer
- EULAR 2012 is set to be the biggest rheumatology event in Europe with over 15,000 scientists, physicians, allied health professionals, and related audiences in attendance from over 115 countries. Over the course of the congress, more than 275 oral and 1400 poster abstract presentations will be featured, with 1,010 invited speaker lectures taking place in 190 sessions
- To find out more about the activities of EULAR, visit: www.eular.org
Journal
Annals of the Rheumatic Diseases