Clinical outcomes of bronchiectasis rheumatoid overlap syndrome in Taiwan

Abstract

<b>Background:</b> Rheumatoid arthritis (RA) is associated with bronchiectasis. Ethnic or geographic differences may exist but the information is limited regarding bronchiectasis with RA (BROS) in Asia. The objective of this study was to investigate clinical characteristics and outcome of BROS in Taiwan. <b>Methods:</b> This multi-institute cohort study included patients with BROS from January 2006 to December 2017. The clinical, functional and microbiological data of patients were retrieved from the Chang Gung Research Database including seven medical facilities in Taiwan. Severe exacerbation was defined as bronchiectasis related hospitalizations or emergency department visits. <b>Results:</b> A total of 343 patients with BROS were identified. 108 patients had severe exacerbation and exhibited significantly more previous exacerbations and higher BACI score (11.1 vs 7.5, p&lt;0.01) than patients without severe exacerbation. As for sputum microbiology, the most prevalent species were Nontuberculous mycobacteria (14.8 %), Pseudomonas aeruginosa (14.2 %), and fungus (5.9%). 68.8% of BROS patients used disease modifying antirheumatic drugs, 7.9% used biological agents and steroid was used significantly higher in those with severe exacerbation (94.4% vs 71.9%, p&lt;0.01). Overall, the respiratory failure rate was 9.3% in one year and 14.6% in three years. The mortality rate was 11.9% in one year and 25.7% in three years. Patients with RA diagnosed before bronchiectasis had a significantly higher cumulative incidence of mortality in a 3-year follow-up than those with RA diagnosed after bronchiectasis. <b>Conclusion:</b> BROS patients had a high mortality rate in Taiwan.&nbsp;The chronology of RA diagnosis is associated with survival outcome in this study.