Elevated anti-cyclic citrullinated peptide antibody titer is associated with increased risk for interstitial lung disease

  • Chase S. CorreiaEmail author
  • Melissa R. Briones
  • Rong Guo
  • Rochella A. Ostrowski
Brief Report


This paper is to examine the relationship between anti-cyclic citrullinated peptide (anti-CCP) antibody titers and the development of interstitial lung disease (ILD) in patients with and without rheumatoid arthritis (RA). A retrospective investigation was conducted on all adult patients tested for anti-CCP between January 1, 2007, and December 31, 2012, in a university healthcare system. Patients with specified exposures or conditions known to cause ILD were excluded. The prevalence of ILD was compared between those with and without a positive CCP. The study population was then divided into four titer groups based on anti-CCP titers: negative, low titer, moderate titer, high titer. Fisher’s exact tests compared the prevalence of ILD among the anti-CCP titer groups. Multivariate logistic regression examined the association between anti-CCP and ILD while controlling for confounders. These analyses were repeated in two subgroups: a “confirmed RA” subgroup and an “unconfirmed RA” subgroup. Two thousand and thirty patients met inclusion criteria and 453 of those had confirmed RA. Progressively higher anti-CCP titer groups developed an increasingly higher prevalence of ILD (p < 0.01). When adjusting for age, tobacco, and a diagnosis of RA, higher anti-CCP titer groups continued to correlate with an increased prevalence of ILD (OR 1.47, 95% CI 1.10–1.96, p < 0.001). This study is the first to show that progressively higher anti-CCP titers correlate with increasing prevalence of ILD, even when adjusting for confounders.


Interstitial lung disease (ILD) Rheumatoid arthritis (RA) Rheumatology 


Compliance with ethical standards




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Copyright information

© International League of Associations for Rheumatology (ILAR) 2019

Authors and Affiliations

  1. 1.Division of RheumatologyNorthwestern Memorial HospitalChicagoUSA
  2. 2.Division of Allergy, Immunology, and RheumatologyLoyola University Medical CenterMaywoodUSA
  3. 3.Department of Medicine Statistics CoreUniversity of CaliforniaLos AngelesUSA

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