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Rheumatoid arthritis patients with co-existent bronchiectasis: increased disease activity, severity and autoantibody positivity


Patients with rheumatoid arthritis ( RA ) and co-existent bronchiectasis ( BRRA ) have a five-fold increased mortality compared to rheumatoid arthritis alone. Yet previous studies have found no difference in clinical and serological markers of RA disease severity between BRRA patients and RA alone.
However, RA disease activity measures such as Disease Activity Score of 28 joints - C-reactive protein ( DAS28-CRP ) and anti-cyclic citrullinated peptide antibodies ( anti-CCP ) have not been studied. Researchers have assessed these parameters in patients with rheumatoid arthritis and co-existent bronchiectasis and rheumatoid arthritis alone.

BRRA patients ( n=53 ) had high-resolution computed tomography proven bronchiectasis without any interstitial lung disease and greater than or equal to 2 respiratory infections/year.
RA alone patients ( n=50 ) had no clinical or radiological evidence of lung disease. DAS28-CRP, rheumatoid factor ( immunoglobulin M ) and anti-CCP were measured in all patients, together with detailed clinical and radiology records.

In BRRA, bronchiectasis predated rheumatoid arthritis in 58% of patients.

BRRA patients had higher DAS28 scores ( 3.51 vs. 2.59 ), higher levels of anti-CCP ( 89% vs. 46% ) and rheumatoid factor ( 79% vs. 52% ) ( P = 0.003 ) compared to RA alone.

Where hand and foot radiology findings were recorded, 29/37 BRRA ( 78% ) and 13/30 ( 43% ) RA alone had evidence of erosive change ( P = 0.003 ).

There were no significant differences between groups in smoking history or disease-modifying anti-rheumatic drug/biologic therapy.

In conclusion, increased levels of RA disease activity, severity and RA autoantibodies are demonstrated in patients with rheumatoid arthritis and co-existent bronchiectasis compared to patients with rheumatoid arthritis alone, despite lower tobacco exposure.
This study has demonstrated that rheumatoid arthritis and co-existent bronchiectasis is a more severe systemic disease than rheumatoid arthritis alone. ( Xagena )

Perry E et al, Int J Rheum Dis 2015; Epub ahead of print

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