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Yang Hu, PhD; Hui-Ping Li, MD, PhD
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FINANCIAL/NONFINANCIAL DISCLOSURES: See earlier cited article for author conflicts of interest.

Department of Respiratory Medicine, Shanghai Pulmonary Hospital; and the School of Medicine, Tongji University, Shanghai, China

CORRESPONDENCE TO: Hui-Ping Li, MD, PhD, Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, 507 Zheng Min Rd, Shanghai 200433, China


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(3):755. doi:10.1016/j.chest.2016.06.037
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We appreciate the reader’s interest in our study and have prepared the following response to the reader’s questions.

First, we used line immunoassay to detect autoantibodies. The kits for line immunoassay and enzyme-linked immunosorbent assay are all from HUMAN-IMTEC. The clinical application of the kits have been approved by the China Food and Drug Administration. All of the tests were conducted in the Department of Laboratory Medicine of Shanghai Pulmonary Hospital according to the kit manuals provided by the manufacturer.

Second, an antinuclear antibody (ANA) test is included in our routine laboratory test to diagnose connective tissue disease (CTD). However, the ANA test is not specific for CTD. A positive ANA test does not confirm CTD, and a negative ANA test cannot exclude CTD. Therefore, we did not include the data of the ANA test result. In our study we analyzed the test results of the HUMEN-IMTEC diagnostic kits, which include a relatively full list of autoantibodies.

Third, clinical tests for anticitrullinated protein antibodies (ACPAs), such as anticyclic citrullinated peptide, antiperinuclear factor, and antikeratin antibody, are currently not available in our hospital. In addition, Jearn and Kim found that ACPA levels did not correlate with the presence of lung disease in patients with rheumatoid arthritis. Contrarily, Yin et al demonstrated that positive serum anticyclic citrullinated peptide 2 was associated with an increased risk of ILD in patients with rheumatoid arthritis. We will test ACPAs in our future studies.

The positive rate for autoantibodies is usually very high in patients with confirmed rheumatic disease. In our study, patients who first presented with extrapulmonary symptoms and then exhibited pulmonary symptoms were diagnosed as having CTD-associated interstitial lung disease (CTD-ILD). The positive rate for autoantibodies in those patients was 80.2%, which is close to the rate (98.1%) in the correspondence by Jearn and Kim. Patients with CTD-ILD treated in the Department of Respiratory Medicine of Shanghai Pulmonary Hospital were often originally admitted because of pulmonary disorders. At hospital admission, the clinical presentations of those patients were mainly pulmonary disorders, and systemic symptoms of CTD-ILD did not appear yet. Therefore, the positive rate for autoantibody in those patients at hospital admission was low. The 2015 European Respiratory Society/American Thoracic Society statement recommends that patients with ILD should be routinely tested for autoantibodies during follow-up. Indeed, we have been routinely testing autoantibodies in our patients at hospital admission and during follow-up.

References

Hu Y. .Wang L.S. .Wei Y.R. .et al Clinical characteristics of connective tissue disease-associated interstitial lung disease in 1,044 Chinese patients. Chest. 2016;149:201-208 [PubMed]journal. [CrossRef] [PubMed]
 
Jearn L.H. .Kim T.Y. . Level of anticitrullinated peptide/protein antibody is not associated with lung diseases in rheumatoid arthritis. J Rheumatol. 2012;39:1493-1494 [PubMed]journal. [CrossRef] [PubMed]
 
Yin Y. .Liang D. .Zhao L. .et al Anti-cyclic citrullinated peptide antibody is associated with interstitial lung disease in patients with rheumatoid arthritis. PLoS One. 2014;9:e92449- [PubMed]journal. [CrossRef] [PubMed]
 
Fischer A. .Antoniou K.M. .Brown K.K. .et al An official European Respiratory Society/American Thoracic Society research statement: interstitial pneumonia with autoimmune features. Eur Respir J. 2015;46:976-987 [PubMed]journal. [CrossRef] [PubMed]
 

Figures

Tables

References

Hu Y. .Wang L.S. .Wei Y.R. .et al Clinical characteristics of connective tissue disease-associated interstitial lung disease in 1,044 Chinese patients. Chest. 2016;149:201-208 [PubMed]journal. [CrossRef] [PubMed]
 
Jearn L.H. .Kim T.Y. . Level of anticitrullinated peptide/protein antibody is not associated with lung diseases in rheumatoid arthritis. J Rheumatol. 2012;39:1493-1494 [PubMed]journal. [CrossRef] [PubMed]
 
Yin Y. .Liang D. .Zhao L. .et al Anti-cyclic citrullinated peptide antibody is associated with interstitial lung disease in patients with rheumatoid arthritis. PLoS One. 2014;9:e92449- [PubMed]journal. [CrossRef] [PubMed]
 
Fischer A. .Antoniou K.M. .Brown K.K. .et al An official European Respiratory Society/American Thoracic Society research statement: interstitial pneumonia with autoimmune features. Eur Respir J. 2015;46:976-987 [PubMed]journal. [CrossRef] [PubMed]
 
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