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Joint Bone Spine
Sous presse. Epreuves corrigées par l'auteur. Disponible en ligne depuis le mardi 11 février 2020
Doi : 10.1016/j.jbspin.2019.12.006
accepted : 20 December 2019
Bronchiectasis in rheumatoid arthritis. A clinical appraisial
 

Ana Catarina Duarte a, , Joanna Porter b, c, Maria José Leandro d
a Rheumatology department, Hospital Garcia de Orta EPE, Avenida Torrado da Silva, 2805-267 Almada, Portugal 
b UCL Respiratory, University College London Hospitals NHS Foundation Trust, 235, Euston Road, Bloomsbury, NW1 2BU London, United Kingdom 
c Center for Interstitial Lung Disease, University College London Hospitals NHS Foundation Trust, 235, Euston Road, Bloomsbury, NW1 2BU London, United Kingdom 
d Center for Rheumatology, University College London Hospitals NHS Foundation Trust, 235, Euston Road, Bloomsbury, NW1 2BU London, United Kingdom 

Corresponding author.
Highlights

The presence of bronchiectasis in patients with rheumatoid arthritis can be as high as 50%, when considering subclinical disease detected on high-resolution computed tomography.
Patients with rheumatoid associated-associated bronchiectasis have a poorer prognosis when compared to those with rheumatoid arthritis or bronchiectasis alone and require regular follow-up, usually by hospital multidisciplinary teams.
Prophylactic antibiotics might be recommended in patients with recurrent respiratory infections, particularly when concomitantly receiving immunosuppressive drugs.

The full text of this article is available in PDF format.
Abstract

Bronchiectasis is defined as irreversibly damaged and dilated bronchi and is one of the most common pulmonary manifestations in patients with rheumatoid arthritis (RA). The model of RA-associated autoimmunity induced in some individuals by chronic bacterial infection in bronchiectasis is becoming increasingly acceptable, although a genetic predisposition to RA-associated bronchiectasis has also been demonstrated. Bronchiectasis should be suspected in RA patients with chronic cough and sputum production or frequent respiratory infections and the diagnosis must be confirmed by thoracic high-resolution computed tomography. Management of patients with RA-associated bronchiectasis includes a multimodal treatment approach. Similar to all patients with non-cystic fibrosis bronchiectasis, patients with RA-associated bronchiectasis benefit from a pulmonary rehabilitation program, including an exercise/muscle strengthening program and an education program with a specific session on airway clearance techniques. Prophylactic antibiotics are recommended for patients with frequent (3 or more infective exacerbations per year) or severe infections requiring hospitalization/intravenous antibiotics and inhaled corticosteroids and long-acting β2-agonists should be used in patients with non-cystic fibrosis bronchiectasis and associated airway hyper-responsiveness. In patients with RA-associated bronchiectasis the use of immunomodulatory drugs has to be carefully considered, as they are essential to control disease activity, despite being associated with an increased infectious risk. Pneumococcal and influenza vaccines are advised to all patients with RA-associated bronchiectasis in order to reduce the risk of infection. Patients with RA-associated bronchiectasis have a poorer prognosis than those with either RA or bronchiectasis alone and require regular follow-up, under the joint care of a rheumatologist and a pulmonologist.

The full text of this article is available in PDF format.

Keywords : Rheumatoid arthritis, Bronchiectasis, Prophylactic antibiotics




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