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Interstitial Lung Disease and Antinuclear AntibodyInterstitial Lung Disease and Antinuclear Antibody: Consider Nonspecific Interstitial Pneumonia Histology and Newer Antibodies FREE TO VIEW

Andrew R. L. Medford
Author and Funding Information

From North Bristol Lung Centre, Southmead Hospital.

Correspondence to: Andrew R. L. Medford, MBChB, MD, FCCP, North Bristol Lung Centre, Southmead Hospital, Westbury-on-Trym, Bristol, BS10 5NB, England; e-mail: andrewmedford@hotmail.com


Financial/nonfinancial disclosures: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2012 American College of Chest Physicians


Chest. 2012;141(5):1360-1361. doi:10.1378/chest.11-3116
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To the Editor:

The recent article by Vij et al1 in CHEST (November 2011) on autoimmune-featured interstitial lung disease (AIF-ILD) raises some further interesting questions. It is well described that connective tissue disease-related interstitial lung disease often is associated with nonspecific interstitial pneumonia (NSIP) histologic test results.2 Intuitively, those patients with AIF-ILD might be expected to have a higher chance of underlying connective tissue disease and, thereby, NSIP on histologic testing and a better prognosis compared with those patients who have standard interstitial lung disease and usual interstitial pneumonia histologic results. It is noted in the study that only a small proportion had NSIP histologic results, and the greater majority had usual interstitial pneumonia histologic results in the AIF-ILD group. Those with a higher antinuclear antibody (ANA) titer level had a better prognosis.

One would postulate a higher prevalence of NSIP and atypical radiologic results in cases associated with a better prognosis. From the article, it seems from the 17 patients with higher titer ANA levels mentioned, there was a higher proportion with NSIP histologic results (20% of patients who receive biopsies vs 6% overall) and slightly higher proportion with atypical radiologic results (38% vs 33% overall) associated with better survival.

Newer antibodies are being detected with time (for example, myositis-specific antibodies3,4), and current autoantibody panels may not detect all antibodies. Therefore, could it be possible that those with a higher ANA titer level or NSIP histologic results (portending a better prognosis) might have additional, more specific, but as yet undetected antibodies?

Vij R, Noth I, Strek ME. Autoimmune-featured interstitial lung disease: a distinct entity. Chest. 2011;1405:1292-1299. [CrossRef] [PubMed]
 
Bouros D, Wells AU, Nicholson AG, et al. Histopathologic subsets of fibrosing alveolitis in patients with systemic sclerosis and their relationship to outcome. Am J Respir Crit Care Med. 2002;16512:1581-1586. [CrossRef] [PubMed]
 
Betteridge ZE, Gunawardena H, McHugh NJ. Novel autoantibodies and clinical phenotypes in adult and juvenile myositis. Arthritis Res Ther. 2011;132:209. [CrossRef] [PubMed]
 
Gunawardena H, Betteridge ZE, McHugh NJ. Newly identified autoantibodies: relationship to idiopathic inflammatory myopathy subsets and pathogenesis. Curr Opin Rheumatol. 2008;206:675-680. [CrossRef] [PubMed]
 

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References

Vij R, Noth I, Strek ME. Autoimmune-featured interstitial lung disease: a distinct entity. Chest. 2011;1405:1292-1299. [CrossRef] [PubMed]
 
Bouros D, Wells AU, Nicholson AG, et al. Histopathologic subsets of fibrosing alveolitis in patients with systemic sclerosis and their relationship to outcome. Am J Respir Crit Care Med. 2002;16512:1581-1586. [CrossRef] [PubMed]
 
Betteridge ZE, Gunawardena H, McHugh NJ. Novel autoantibodies and clinical phenotypes in adult and juvenile myositis. Arthritis Res Ther. 2011;132:209. [CrossRef] [PubMed]
 
Gunawardena H, Betteridge ZE, McHugh NJ. Newly identified autoantibodies: relationship to idiopathic inflammatory myopathy subsets and pathogenesis. Curr Opin Rheumatol. 2008;206:675-680. [CrossRef] [PubMed]
 
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