Decreased survival in patients with co-existent rheumatoid arthritis and bronchiectasis

Swinson, D. R.; Symmons, Deborah; Suresh, U R; Jones, Monica; Booth, J

doi:10.1093/rheumatology/36.6.689

Cited by 96 publications

(61 citation statements)

References 2 publications

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“…47 In patients with RAassociated lung disease the 5-year survival rate was reported as 87.1% in the BR group, and only patients with RA and interstitial lung disease had a lower 5-year survival rate (36.6%). 48 Longitudinal studies of treatment interventions in these patients are urgently required.…”

Section: Prognosismentioning

confidence: 99%

Coexistence of Bronchiectasis and Rheumatoid Arthritis: Revisited

2013

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The presence of bronchiectasis (BR) in patients with rheumatoid arthritis (RA) has been recognized for many decades; nevertheless, little research has been undertaken in this area. It is important to recognize that BR coexistent with RA differs from the other types of BR. The purpose of this descriptive review was to delineate the epidemiology, etiology, risk factors, pulmonary function testing, imaging, prognosis and management of concomitant BR and RA. To inform our study we searched the PubMed, EMBASE, CINAHL, and MEDLINE databases, using combinations of the following key words: computed tomography, lung function tests, rheumatoid arthritis, bronchiectasis, biological agents, and interstitial lung disease. The number of published papers covering this topic is limited, but several relevant conclusions can be drawn. Patients with concomitant RA and BR have worse obstructive airways disease, increased susceptibility to recurrent pulmonary infections, faster lung function decline, and higher mortality, compared with subjects with either RA or BR alone. The use of disease-modifying anti-rheumatic drugs (both biological and non-biological) for RA in RA-BR patients imparts a further challenge in managing these patients. Although there are not any published guidelines on the management of coexisting RA-BR, we have attempted to provide such recommendations, based on the literature review and our experience.

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Section: Prognosismentioning

confidence: 99%

Coexistence of Bronchiectasis and Rheumatoid Arthritis: Revisited

2013

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“…These events gradually worsen the health-related quality of life and lung function of affected patients [4][5][6]. In recent years, bronchiectasis has become a major health concern for several reasons: a significant increase in the number of diagnoses [7,8], the increase in the mortality rate [9] and in hospital admissions [10], the considerable health costs involved (US$7827 per hospitalisation) [10], its negative impact on the quality of life [6] and pulmonary function of patients (annual loss of nearly 50 mL of forced expiratory volume in 1 s (FEV1)) [5] and its deleterious effects on underlying diseases [11].…”

Section: Introductionmentioning

confidence: 99%

Multidimensional approach to non-cystic fibrosis bronchiectasis: the FACED score

Martínez‐García

Gracia

Relat

et al. 2013

European Respiratory Journal

372

255

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Bronchiectasis is a multidimensional disease and, therefore, its severity or prognosis cannot be adequately quantified by analysing one single variable. The objective of the present study was to develop a multidimensional score that classifies the severity of bronchiectasis according to its prognosis. This is an observational multicentre study including 819 patients diagnosed with non-cystic fibrosis bronchiectasis using high-resolution computed tomography. 397 subjects were selected at random to construct the score while the remaining 422 were used for its validation. The outcome was 5-year all-cause mortality after radiological diagnosis. A logistic regression analysis was used to select the variables included in the final score.The final seven-point score incorporated five dichotomised variables: forced expiratory volume in 1 s % predicted (F, cut-off 50%, maximum value 2 points); age (A, cut-off 70 years, maximum value 2 points); presence of chronic colonisation by Pseudomonas aeruginosa (C, dichotomic, maximum value 1 point); radiological extension (E, number of lobes affected, cut-off two lobes, maximum value 1 point); and dyspnoea (D, cut-off grade II on the Medical Research Council scale, maximum value 1 point) to construct the FACED score. The validation cohort confirmed the score's validity.We conclude that this easy-to-use multidimensional grading system proved capable of accurately classifying the severity of bronchiectasis according to its prognosis. @ERSpublications An easy-to-use multidimensional grading system accurately classifies bronchiectasis severity according to prognosis

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“…One study demonstrated lower infective exacerbations of BR in patients on DMARDs 10 , while the other found more infective exacerbations in patients on biologics 11 . The coexistence of these conditions has significant health implications, indeed patients with RA and BR have been shown to have mortality rates 7.3 times that of the general population, 5 times that of patients with RA alone and 2.4 times that of patients with BR alone 12 .…”

Section: Introductionmentioning

confidence: 99%

Increased disease activity, severity and autoantibody positivity in rheumatoid arthritis patients with co‐existent bronchiectasis

et al. 2015

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AimPatients 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, so we assessed these parameters in patients with BRRA and RA alone.MethodsBRRA patients (n = 53) had high‐resolution computed tomography proven bronchiectasis without any interstitial lung disease and ≥ 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.ResultsIn BRRA, bronchiectasis predated RA 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.ConclusionsIncreased levels of RA disease activity, severity and RA autoantibodies are demonstrated in patients with RA and co‐existent bronchiectasis compared to patients with RA alone, despite lower tobacco exposure. This study demonstrates that BRRA is a more severe systemic disease than RA alone.

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Decreased survival in patients with co-existent rheumatoid arthritis and bronchiectasis

Cited by 96 publications

References 2 publications

Coexistence of Bronchiectasis and Rheumatoid Arthritis: Revisited

Coexistence of Bronchiectasis and Rheumatoid Arthritis: Revisited

Multidimensional approach to non-cystic fibrosis bronchiectasis: the FACED score

Increased disease activity, severity and autoantibody positivity in rheumatoid arthritis patients with co‐existent bronchiectasis

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