TY - JOUR T1 - Association of antinuclear antibody seropositivity with inhaled environmental exposures in patients with interstitial lung disease JF - ERJ Open Research JO - erjor DO - 10.1183/23120541.00254-2021 SP - 00254-2021 AU - Kathleen Biblowitz AU - Cathryn Lee AU - Daisy Zhu AU - Imre Noth AU - Rekha Vij AU - Mary E. Strek AU - Shashi K. Bellam AU - Ayodeji Adegunsoye Y1 - 2021/01/01 UR - http://openres.ersjournals.com/content/early/2021/08/12/23120541.00254-2021.abstract N2 - Background Interstitial lung diseases (ILD) are diffuse parenchymal lung disorders that cause substantial morbidity and mortality. In patients with ILD, elevated antinuclear antibody (ANA) titers may be a sign of an autoimmune process. Inhalational exposures contribute to ILD pathogenesis and affect prognosis and may trigger autoimmune disease. The association of inhalational exposures with ANA seropositivity in ILD patients is unknown.Methods This was a retrospective cohort study of adult ILD patients from five US centers. Exposures to tobacco, inhaled organic antigens, and inhaled inorganic particles were extracted from medical records. A multivariable logistic regression model was used to analyse the effects of confounders including age, ILD diagnosis, gender, and exposure type on ANA seropositivity.Results Among 1,265 patients with ILD, there were more ANA seropositive (58.6%, n=741) than ANA seronegative patients (41.4%, n=524). ANA seropositive patients had lower total lung capacity (69% versus 75%, p<0.001) and forced vital capacity (64% versus 70%, p<0.001) than patients who were ANA seronegative. Amongst patients with tobacco exposure, 61.4% (n=449) were ANA positive compared to 54.7% (n=292) of those without tobacco exposure. In multivariable analysis tobacco exposure remained independently associated with increased ANA seropositivity (OR=1.38, 95%CI=1.12–1.71). This significant difference was similarly demonstrated among patients with and without a history of inorganic exposures (OR=1.52, 95%CI=1.12–2.07).Conclusion Patients with ILD and inhalational exposure had significantly higher prevalence of ANA seropositivity than those without reported exposures across ILD diagnoses. Environmental and occupational exposures should be systematically reviewed in patients with ILD, particularly those with ANA seropositivity.FootnotesThis manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.Conflict of interest: Kathleen BiblowitzConflict of interest: Cathryn LeeConflict of interest: Daisy ZhuConflict of interest: Imre NothConflict of interest: Rekha VijConflict of interest: Mary E. Strek has received institutional support to conduct ILD clinical trials for Boehringer Ingelheim and Galapagos, fees for clinical trial adjudication commiittee service from Fibrogen and editorial support from Boehringer Ingelheim.Conflict of interest: Shashi K. Bellam has received speaking and advisory board fees from Genentech.Conflict of interest: Ayodeji Adegunsoye has received speaking and advisory board fees from Genentech and Boehringer Ingelheim and is supported by a career development award from the National Heart, Lung, and Blood Institute (NHLBI K23HL146942). ER -