Department of Respiratory Medicine, Copenhagen University Hospital Hvidovre, Denmark.
Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Chron Respir Dis. 2021 Jan-Dec;18:1479973121994565. doi: 10.1177/1479973121994565.
Rheumatoid arthritis (RA) is a chronic autoimmune disease primarily affecting joints but often also associated with lung involvement such as bronchiectasis (BE). The aim of the present systematic review and meta-analysis is to provide an update on the current evidence regarding the prevalence and association between RA and BE. This systematic review and meta-analysis was performed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines with literature search using the terms 'Bronchiectasis AND Rheumatoid Arthritis' without a date limitation on PubMed during May 2020. A total of 28 studies fulfilled the predefined criteria and were included in the present review, with 19 being cross-sectional studies. Twenty-three studies were included in the meta-analysis. The pooled prevalence estimate was 2.69% (95% CI 1.63-4.42) in clinically defined BE, and 24.9% (95% CI 19.21-31.67) in radiologic disease. Many inconsistencies exist regarding potential risk factors for BE in RA patients such as gender, RA duration and severity, as both negative and positive associations have been reported. Although very little is known about possible causative mechanisms between RA and BE, potential pathways might be antigenic stimulation from pulmonary mucus and/or systemic inflammation from joint disease affecting the lungs. At present, the available evidence of bronchiectasis in patients with RA is insufficient to identify RA-associated risk factors for the development of BE, possibly apart from duration of RA, and, consequently, also to fully explore a possible causal relationship between the two disease. However, the increased prevalence of BE in RA patients warrants further studies to explore the association between RA and BE.
类风湿关节炎（RA）是一种慢性自身免疫性疾病，主要影响关节，但也常伴有肺部受累，如支气管扩张症（BE）。本系统评价和荟萃分析的目的是提供 RA 和 BE 之间目前的流行率和关联的最新证据。本系统评价和荟萃分析是按照系统评价和荟萃分析的首选报告项目（PRISMA）指南进行的，使用术语“支气管扩张症和类风湿关节炎”在 2020 年 5 月期间在 PubMed 上进行了无日期限制的文献搜索。共有 28 项研究符合预定标准，并被纳入本综述，其中 19 项为横断面研究。23 项研究纳入荟萃分析。在临床定义的 BE 中，汇总的患病率估计为 2.69%（95%CI 1.63-4.42），在放射学疾病中为 24.9%（95%CI 19.21-31.67）。关于 RA 患者 BE 的潜在危险因素存在许多不一致之处，如性别、RA 持续时间和严重程度，因为既有阴性也有阳性关联的报道。尽管人们对 RA 和 BE 之间可能的因果机制知之甚少，但潜在的途径可能是肺部粘液的抗原刺激和/或关节疾病的全身炎症对肺部的影响。目前，RA 患者支气管扩张症的证据不足以确定 RA 相关的 BE 发展风险因素，除了 RA 的持续时间外，可能还有其他因素，因此也无法充分探讨这两种疾病之间的可能因果关系。然而，RA 患者中 BE 的患病率增加需要进一步研究来探讨 RA 和 BE 之间的关联。
