Meta-analysis identifies the major impact of patient classification on the anti-citrullinated protein antibodies (ACPA) association with rheumatoid arthritis-associated interstitial lung disease (RA-ILD)
Authors' conclusion
Our results validate the ACPA association with RA-ILD, reinforce the importance of study design, and suggest the need to consider if studies relying on chest CT for classification could be more fruitful in the search for RA-ILD biomarkers.
Study context
- Population
- Studies reporting ACPA in RA-ILD and RA-control groups (Web of Science and PubMed)31 eligible data sets
- Participants
- 14 vs 16
- Comparison
- ACPA association with RA-ILD (vs RA controls), by patient classification method: chest CT vs multifactorial criteria
- Chest CTn = 14
- Multifactorial criterian = 16reference
- Outcome
- Moderators of the ACPA association with RA-ILD
Methodological detailsmoderator analysis, sensitivity analyses
- Moderator analysis
- Sensitivity analyses
Pooled result
As reported in the abstract
ACPA association with RA-ILD by classification method (outlier excluded)
| Group | OR (95% CI 2.12-4.38) | OR (95% CI 1.18-2.03) |
|---|---|---|
| Chest CT | 3.05 | |
| Multifactorial criteria | 1.55 |
OR (95% CI 2.12-4.38)
Chest CT3.05
Multifactorial criteria— not stated in the abstract
OR (95% CI 1.18-2.03)
Chest CT— not stated in the abstract
Multifactorial criteria1.55
- Chest CT vs Multifactorial criteria: P = 0.0047 for the contrast — moderator accounted for significant heterogeneity (pQ = 0.079); robust in sensitivity analyses; only moderator found
Further pooled results
Heterogeneity of ACPA association
- Heterogeneity, all data sets (pQ)
- 5.7 × 10-7
- Heterogeneity attributable to outlier study
- 58.1%
- Heterogeneity after outlier exclusion (pQ)
- 0.004
- Outlier recruited cases and controls in different place and time contexts
Original publication
Meta-analysis identifies the major impact of patient classification on the ACPA association with rheumatoid arthritis-associated interstitial lung disease (RA-ILD). Arthritis Res Ther. Published 19 July 2025. doi:10.
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