Pulmonary function tests and high resolution computed tomography of the lungs in patients with rheumatoid arthritis

Cortet, Bernard; Pérez, Thierry; Roux, Nicolas; Flipo, René‐Marc; Duquesnoy, B; Delcambre, B; Rémy‐Jardin, Martine

doi:10.1136/ard.56.10.596

Cited by 139 publications

(121 citation statements)

References 21 publications

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“…These findings do not contradict the claim that rheumatoid lung disease occurs more frequently in patients with longstanding RA 2 . A high prevalence of airway abnormalities was also observed in several previous HRCT studies on patient populations with relatively long mean disease durations [3][4][5] .…”

Section: Drs Mori and Cho Replysupporting

confidence: 49%

Drs. Mori and Cho reply

Mori¹,

Cho²

2009

J Rheumatol

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Section: Drs Mori and Cho Replysupporting

confidence: 49%

Drs. Mori and Cho reply

Mori¹,

Cho²

2009

J Rheumatol

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“…The erythrocyte sedimentation rate tends to be higher in those with BR, but there were no other significant differences between the 2 groups, either hematologically or serologically. [14][15][16] Demoruelle et al postulated a link between autoimmunity in RA and airway damage. These authors studied 3 groups of patients: subjects without inflammatory arthritis but with elevated anti-cyclic citrullinated peptide (CCP) antibodies, antibodies-negative controls, and subjects with early seropositive RA.…”

Section: Etiologymentioning

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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“…Modern studies have found symptomatic bronchiectasis with a prevalence of 2.7% in RA subjects, compared to 0.03% in the general population 2 . High resolution computed tomography (HRCT) studies demonstrate the prevalence to be much higher, with radiological BR in RA populations repeatedly reported in the region of 30% [3][4][5][6] .…”

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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Pulmonary function tests and high resolution computed tomography of the lungs in patients with rheumatoid arthritis

Cited by 139 publications

References 21 publications

Drs. Mori and Cho reply

Drs. Mori and Cho reply

Coexistence of Bronchiectasis and Rheumatoid Arthritis: Revisited

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

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