The prevalence of bronchiectasis in patients with rheumatoid arthritis (RA) was nearly 20% in studies that used high-resolution computed tomography (HCRT) for chest imaging, according to results of a systematic review and meta-analysis published in Seminars in Arthritis and Rheumatism.

In patients with RA, bronchiectasis increases mortality by 5-fold compared with patients with RA but without bronchiectasis, it was noted. Despite these outcomes, the prevalence and risk factors for RA-associated bronchiectasis is poorly understood.

In this systematic review, researchers queried the PubMed and EMBASE databases for published reports of RA-associated bronchiectasis prevalence and risk factors. Meta-analyses were conducted using random effects and fixed effects modeling to estimate the prevalence of bronchiectasis in patients with RA.


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In total, 41 studies were identified including 34 that reported on prevalence, 5 on risk factors, and 2 on both. In the 36 studies that reported on prevalence, there were 608 cases of bronchiectasis among 8569 patients with RA. The pooled prevalence was 18.7% (95% CI, 13.7-24.3%) using random effects and 3.8% (95% CI, 3.3-4.2%) using fixed effects modeling.

Among retrospective (n=12) and prospective studies (n=23), the pooled prevalence of bronchiectasis in the random effects meta-analysis was 15.5% (95% CI, 7.5-25.5%) and 20.7% (95% CI, 14.7-27.4%), respectively. When only studies that used HRCT for chest imaging were considered (n=24), the pooled prevalence of bronchiectasis was 22.6% (95% CI, 16.8-29.0%) using random effects modeling.

In all, 7 studies found statistically significant risk factors for RA-associated bronchiectasis including older age, African American ethnicity, longer RA disease duration, genetics (HLA and CFTR mutations), undetectable levels of the biomarker mannose binding lectin, and no biologic disease-modifying antirheumatic drug use.

Limitations of the study included the inability to distinguish between isolated bronchiectasis and bronchiectasis secondary to architectural distortion from fibrotic lung disease, exclusion of nonstatistically significant risk factors from the individual studies that might have been important in the pooled analyses, bias due to the use of 2 reviewers, and omission of subsequent published studies.

The researchers concluded, “Future studies should standardize methods to identify [RA-associated bronchiectasis] cases and investigate the natural history and clinical course given the relatively high prevalence that we report.”

Reference

Martin LW, Prisco LC, Huang W, McDermott G, Shadick NA, Doyle TJ, Sparks JA. Prevalence and risk factors of bronchiectasis in rheumatoid arthritis: A systematic review and meta-analysis. Published online August 20, 2021. doi:10.1016/j.semarthrit.2021.08.005.