Choi Hayoung, Han Kyungdo, Jung Jin Hyung, De Soyza Anthony, Kim Hyungjin, Shin Dong Wook, Lee Hyun
Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea.
Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea.
Ther Adv Respir Dis. 2025 Jan-Dec;19:17534666251360071. doi: 10.1177/17534666251360071. Epub 2025 Aug 5.
Comorbid rheumatoid arthritis (RA) is known to be associated with excess mortality in patients with bronchiectasis. However, whether excess mortality is affected by RA seropositivity and is altered by using disease-modifying anti-rheumatic drugs (DMARDs) remains unknown.
To assess the association between comorbid RA and mortality in participants with bronchiectasis, plus the impacts of seropositivity and DMARDs on this association.
A retrospective cohort study.
Mortality rates were compared between participants with bronchiectasis-RA overlap syndrome (BROS) ( = 3355; 2632 seropositive RA (SPRA) and 723 seronegative RA (SNRA)) and 1:5 age- and sex-matched participants with bronchiectasis only ( = 16,240) who were enrolled between 2010 and 2017 in the Korean National Health Insurance Service database. The participants were followed up from 1 year after RA diagnosis or the corresponding index date to the date of death, censored date, or 31 December 2020.
During a median follow-up of 5.8 years (interquartile range, 4.2-7.8 years), participants with BROS revealed a 2.09-fold higher mortality risk compared with participants with bronchiectasis only, even after adjusting for potential confounders (95% confidence interval (CI), 1.88-2.33). In an analysis of RA serologic status using a fully adjusted model, participants with SPRA and those with SNRA showed 2.34-fold (95% CI, 2.09-2.62) and 1.29-fold (95% CI, 1.01-1.65) increased risks, respectively, than participants with bronchiectasis only. DMARDs use was related to increased mortality.
The presence of RA doubles the mortality risk in patients with bronchiectasis. Increased mortality risk was more evident in patients with SPRA and those who use DMARDs. Causality cannot be ascertained, but these data suggest that rheumatic inflammation may affect disease progression and excess mortality in patients with BROS.
已知合并类风湿关节炎（RA）与支气管扩张患者的额外死亡率相关。然而，额外死亡率是否受RA血清阳性影响以及是否会因使用改善病情抗风湿药物（DMARDs）而改变仍不清楚。
评估合并RA与支气管扩张患者死亡率之间的关联，以及血清阳性和DMARDs对此关联的影响。
一项回顾性队列研究。
比较2010年至2017年纳入韩国国民健康保险服务数据库的支气管扩张-RA重叠综合征（BROS）患者（n = 3355；2632例血清阳性RA（SPRA）和723例血清阴性RA（SNRA））与年龄和性别匹配的单纯支气管扩张患者（n = 16240）的死亡率。参与者从RA诊断后1年或相应索引日期开始随访至死亡日期、审查日期或2020年12月31日。
在中位随访5.8年（四分位间距，4.2 - 7.8年）期间，即使在调整潜在混杂因素后，BROS患者的死亡风险仍比单纯支气管扩张患者高2.09倍（95%置信区间（CI），1.88 - 2.33）。在使用完全调整模型分析RA血清学状态时，SPRA患者和SNRA患者的风险分别比单纯支气管扩张患者增加2.34倍（95% CI，2.09 - 2.62）和1.29倍（95% CI，1.01 - 1.65）。使用DMARDs与死亡率增加相关。
RA的存在使支气管扩张患者的死亡风险加倍。血清阳性患者和使用DMARDs的患者死亡风险增加更为明显。因果关系无法确定，但这些数据表明风湿性炎症可能影响BROS患者的疾病进展和额外死亡率。
