BackgroundExtra-articular disease in rheumatoid arthritis (RA) occurs in nearly 50% of patients, the lung being a common site of complication. (1) Raised RF and anti-CCP titers have been associated with the development of pulmonary disease. Smoking in genetically susceptible individuals can result in protein citrullination and enhancement of autoimmune reactivity (2).ObjectivesOur aim was to explore the relationship between the presences of RhF and anti-CCP antibody with pulmonary manifestations in the following groups: RF positive only (group 1), Anti-CCP factors positive only (group 2) RF and anti-CCP positive in combination (group 3) we also explored the relationship between smoking, seropositivity and lung disease.MethodsIn this retrospective cross-sectional observational study of 2088 patients who had a RF and anti-CCP antibodies tested during Nov-2015 and Oct-2016 at Royal Wolverhampton Trust. Out of 2088, 1662 patients tested negative for both anti-CCP and RF and were excluded from analysis. 426 out of 2088 tested positive, of which 89 patients were anti-CCP only positive, 100 patients were RF only positive and 237 patients were positive for both antibodies. Data was collected on 89 patients from each group. Data collection included patient age, gender, smoking status, pulmonary manifestations, RF and anti-CCP titer, background of RA and current medications including DMARDS and biologics.ResultsIn group 1 (30) 33.7% of RF positive patients suffered from RA, with (63) 70.7% in group 2 and (82) 92.1% in group 3(P=0.00001). In group 1 17% were current or ex-smokers, 29% in group 2 and 52.7% in group 3(P=0.02). Lung disease was present in 13.4% from group 1, 7.8% from group 2 and 12.3% from group 3 with no significant statically difference between the three groups (p=0.376). In group 2 and 3 all patients with lung disease had RA. From group 1, 50% of those with lung disease had a diagnosis of COPD, followed by 20% with bronchiectasis and 10% with ILD. Of note patients with a diagnosis of COPD had a higher titer of RF. In group 2 a third of patients with lung disease had a diagnosis of COPD and ILD respectively, and again these patients had higher titers of anti-CCP. In group 3 13.4% suffered from lung manifestations and 37.5% had a diagnosis of pulmonary fibrosis, 12.5% diagnosed with ILD and the remaining 50% had COPD and pleural disease.ConclusionAntibody positivity was associated with higher prevalence of RA. Our data provide evidence for the association between smoking and raised antibody titers, especially with anti-CCP antibodies. Lung disease was more strongly associated with RF than anti CCP even though the proportion of smokers was higher in patients with positive anti CCP compared than RF. However lung pathology varied with airway obstruction being more prevalent in RF positive patients compared with fibrosis in patients who were RF and CCP positive. Furthermore, our findings suggest that RF is more strongly associated with lung disease than anti CCP though citrullination is thought to start in the lu...

Background Epidemiological studies on rheumatic diseases in India are few. Vasculitic disorders are under-diagnosed and under-reported. Epidemiological data of AAV is especially scant from western India.1 Objectives To describe the clinical profile and outcome of patients with ANCA-associated vasculitis (AAV) from western India. Methods Demographic profile, clinical features, laboratory data, treatment details, BVAS, EULAR disease stages and therapeutic outcome of patients were analyzed retrospectively. The patients were diagnosed and followed up in the Rheumatology clinic between 2003 and 2011. The patients were classified as per the EULAR guidelines for clinical trials in AAV.2 Results A total of 75 patients were studied. 41were females (55%) and 34 were males (45%). Mean age of the patients was 43.4±20.7 years and mean duration of illness 18±16.6 months. The clinical diagnoses were Granulomatosis with polyangiitis (Wegener’s) (n=33,44%), Churg-Strauss Syndrome (n=7,9%), Microscopic polyangiitis (n=2) and unclassified AAV (n=33,44%). Systemic involvement: Upper respiratory tract (67%) & lower respiratory tract (60%), skin (44%), kidney (40%), peripheral nerves (40%) and eye (31%). c-ANCA was positive in 41 (53%) and p-ANCA in 34 (47%). 53% had anemia, 59% had leukocytosis and 57% had thrombocytosis. Histopathology (from relevant sites) and imaging studies were obtained in 43 (60%) and 58 (80%) patients respectively. Mean BVAS at presentation was 17.5±7.5. The EULAR disease stage at presentation were: Localised (11%), early systemic (53%), generalised (33%) and severe (3%). Methylprednisolone (70%), cyclophosphamide (60%), methotrexate (25%) and azathioprine (15%) were used for induction. 3 patients underwent plasmapheresis. Maintainence immunosuppressants were prednisolone (96%), cyclophosphamide (39%), azathioprine (33%), methotrexate (28%), and mycophenolate (8%). The mean duration of follow-up was 35.2±20.8 months. 54 (72%) patients achieved remission. Low disease activity was seen in 13 (17%) patients and refractory disease in 8 (11%). Mean duration to achieve remission was 6.7±3.6months. Relapse occurred in 14/54 (26%) patients after a mean duration of 21 months. Death occurred in 3 (4%) patients (pulmonary hemorrhage in 2, MAS in 1). Conclusions GPA (Wegener’s) and Unclassified AAV were the common clinical diagnoses. Early systemic and generalised disease were the commonest EULAR types. Methylprednisolone and cyclophosphamide were the common induction agents while prednisolone and cyclophosphamide were the common maintenance agents. Majority achived remission but relapses were common. References Joshi VR, G Mittal. Vasculitis–Indian perspective. J Assoc Physicians India 2006;54(Suppl):12–14 Hellmich B,Flossmann O,Gross WL,Bacon P,Willem Cohen-Tervaert J,Guillevin L,et al.EULAR recommendations for conducting clinical studies and/or clinical trials in systemic vasculitis:focus on anti-neutrophil cytoplasm antibody-associated vasculitis. Ann Rheum Dis 2007;66:605–17 Disclosure of Interest None Declared

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