Shadick N A, Fanta C H, Weinblatt M E, O'Donnell W, Coblyn J S
Department of Rheumatology and Immunology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115.
Medicine (Baltimore). 1994 May;73(3):161-70.
Bronchiectasis as a feature of rheumatoid arthritis is considered rare and, in most series, has preceded rheumatoid arthritis. We identified 23 patients with rheumatoid arthritis and bronchiectasis at the Brigham and Women's Hospital followed between 1984 and 1991, 18 of whom had arthritis preceding lung disease. The 18 patients with rheumatoid arthritis and subsequent bronchiectasis had a mean age of 63.8 years. Fourteen were women and 4 were men, with a mean arthritis duration of 24.7 years before bronchiectasis developed. Most patients had seropositive and nodular disease. All but 1 had advanced radiographic changes of rheumatoid arthritis, and many had received joint replacement surgery. In addition to standard treatment regimens, 17 patients had received corticosteroids. Productive cough, hemoptysis, and dyspnea were the most common respiratory symptoms and were present for an average of 4.3 years prior to bronchiectasis diagnosis. The most common radiographic abnormalities were bibasilar diffusely increased interstitial markings and focal infiltrates, although nodules, bullae, cysts, and air-fluid levels were found. Common pulmonary-function abnormalities were obstructive and/or restrictive abnormalities. Three patients died of complications relating to bronchiectasis. Five patients with rheumatoid arthritis had antecedent bronchiectasis. Compared with patients with rheumatoid arthritis and subsequent bronchiectasis, those with antecedent lung disease had milder arthritis (stage I or II radiographic changes, p < 0.001), a lower frequency of rheumatoid nodules (p < 0.05) and a lower comorbidity score (5.8 versus 9.4, p < 0.01). They also had received fewer disease-modifying agents for the treatment of their rheumatoid arthritis. Bronchiectasis can be a feature of rheumatoid arthritis and is often found in patients with severe, long-standing nodular disease. Recurrent pulmonary infections and respiratory failure occur and may be fatal.
支气管扩张作为类风湿关节炎的一个特征被认为较为罕见，并且在大多数病例系列中，支气管扩张先于类风湿关节炎出现。我们在1984年至1991年期间对布莱根妇女医院的23例患有类风湿关节炎和支气管扩张的患者进行了随访，其中18例关节炎先于肺部疾病出现。这18例患有类风湿关节炎并随后出现支气管扩张的患者平均年龄为63.8岁。14例为女性，4例为男性，在支气管扩张发生前关节炎的平均病程为24.7年。大多数患者血清学阳性且有结节性病变。除1例患者外，所有患者均有类风湿关节炎的晚期影像学改变，许多患者接受过关节置换手术。除标准治疗方案外，17例患者接受过皮质类固醇治疗。咳痰、咯血和呼吸困难是最常见的呼吸道症状，在支气管扩张诊断前平均出现4.3年。最常见的影像学异常是双肺底部弥漫性间质纹理增多和局灶性浸润，尽管也发现了结节、肺大疱、囊肿和气液平面。常见的肺功能异常是阻塞性和/或限制性异常。3例患者死于与支气管扩张相关的并发症。5例类风湿关节炎患者先前有支气管扩张。与类风湿关节炎并随后出现支气管扩张的患者相比，先前有肺部疾病的患者关节炎较轻（影像学改变为I期或II期，p<0.001），类风湿结节的发生率较低（p<0.05），合并症评分较低（分别为5.8和9.4，p<0.01）。他们接受用于治疗类风湿关节炎的改善病情药物也较少。支气管扩张可以是类风湿关节炎的一个特征，并且常见于患有严重、长期结节性疾病的患者。反复肺部感染和呼吸衰竭会发生，且可能致命。
