Clinical Characteristics And Risk Factors Of Patients With Rheumatoid Arthritis Complicated With Bronchiectasis

Objective:The incidence of bronchiectasis was 2.7% in the RA population compared to 0.03%in the general population.In fact,this figure is still on the rise.The prognosis of patients with RA associated bronchiectasis is worse than that of patients with RA alone or bronchiectasis alone.The mortality rate of RA patients with bronchiectasis was 5 times higher than that of RA patients,7.3 times higher than that of the general population,and2.4 times higher than that of bronchiectasis patients.Therefore,early diagnosis and treatment of RA related bronchiectasis is very important.Studies on the clinical characteristics and risk factors of RA patients with bronchiectasis are mainly conducted abroad,and few studies are reported in China.In this study,we compared the clinical characteristics between RA patients and RA patients complicated with bronchiectasis,and analyzed the independent risk factors for clinical diagnosis and treatment.This study will be helpful to guide clinical diagnosis and treatment,and improve the prognosis of patients with RA.Methods:According to the inclusion and exclusion criteria,patients who were admitted to the Department of Rheumatology and Immunology and the Department of Respiratory and Critical Care Medicine of the Affiliated Hospital of Qingdao University from August 1,2017 to January 1,2019 were included,and their clinical data were retrospectively analyzed.These patients were divided into three groups according to the primary disease:(1)RA group(2)RA-BR group(3)BR group.The general data and laboratory tests of the two groups of RA and RA-BR patients were compared and analyzed,and the types of sputum colonization bacteria in RA-BR group and BR group were compared and analyzed.Further more,Logistic regression analysis was used to analyze the independent risk factors of RA patients with bronchiectasis.Results:1.A total of 93 RA patients and 57 RA patients with bronchiectasis were included.In general clinical data,only age(P=0.002)and RA duration(P=0.001)were statistically significant between the two groups.Compared with simple RA patients,RA-BR patients were older and had a longer course of disease.In laboratory tests,CRP(P=0.021),RF(P=0.041)and anti-CCP(P=0.003)were statistically significant between the two groups.And there were significant differences in anti-cyclic citrullinated peptide antibody(X~2=14.942,P=0.002)and rheumatoid factor(X~2=60.218,P<0.001)between the two groups.The positive rate of RF and anti-CCP was higher in RA-BR patients,and the concentration grading was also higher.2.There was a significant difference in DAS-28 score between RA group and RA-BR group(P=0.001).There was no significant difference in activity classification between the two groups(X~2=1.643,P=0.200).3.Streptococcus viridans and Pseudomonas aeruginosa were the main colonized bacteria in sputum culture of RA-BR group and BR group.There was no significant difference in the species of colonized bacteria between this two groups.4.There were significant differences in age(P=0.007),duration of RA(P<0.001),rheumatoid factor(P<0.001),anti-cyclic citrullinated peptide antibody(P<0.001)and DAS-28 score(P=0.001)between RA patients with bronchiectasis and RA patients.Conclusion:1.Compared with patients with RA alone,patients with RA combined with bronchiectasis had higher disease activity and severity.2.In RA patients with bronchiectasis,the course of RA was longer than that of BR in 78.95% of the patients,indicating that bronchiectasis may be one of the late complications of RA.3.There is no difference in the species of colonized bacteria in sputum culture between RA patients with bronchiectasis and BR patients.Pseudomonas aeruginosa and Streptococcus viridis were dominant in both groups.4.Age,duration of RA,rheumatoid factor,anti-cyclic citrullinated peptide antibody and DAS-28 score are independent risk factors for RA complicated with bronchiectasis.