Demographic, Lifestyle, and Serologic Risk Factors for Rheumatoid Arthritis-Associated Bronchiectasis: Role of RA-related Autoantibodies
Abstract
Objective To investigate demographic, lifestyle, and serologic risk factors for isolated rheumatoid arthritis-associated bronchiectasis (RA-BR) not due to interstitial lung disease (ILD).
Methods We performed a case-control study using RA patients from the Mass General Brigham Biobank. We reviewed the records of all RA patients meeting 2010 ACR/EULAR criteria with CT chest imaging to identify RA-BR cases and controls with RA and RA-related lung disease. For each patient, the CT chest imaging performed closest to enrollment was independently reviewed by two radiologists for the presence of RA-related lung diseases. Cases had clinical and radiologic evidence of RA-BR without interstitial lung abnormalities on imaging. Controls had RA and no evidence of bronchiectasis or ILD. We examined the associations between demographic, lifestyle, and serologic factors with RA-BR using multivariable logistic regression.
Results We identified 57 cases of isolated RA-BR and 360 RA controls without RA-related lung disease. In multivariable models, RA-BR was associated with older age of RA onset (OR 1.37 per 10 years, 95%CI 1.02-1.82), lower BMI at RA diagnosis (OR 0.94 per kg/m2, 95%CI 0.89- 0.99), seropositive RA (OR 3.96 1.84-8.53), positive rheumatoid factor (OR 4.40 95%CI 2.14- 9.07), and positive anti-CCP (OR 3.47 95%CI 1.65-7.31). Higher-titer RA-related autoantibodies were associated with higher odds of RA-BR.
Conclusion Seropositivity, older age at RA diagnosis, and lower BMI at RA onset were associated with isolated bronchiectasis in RA not due to ILD. These findings expand the list of potential risk factors for RA-BR and suggest a pathogenic link between airway inflammation and RA-related autoantibodies.