Association between bronchiectasis and smoking in patients with rheumatoid arthritis.

T here is a well recognised association between rheumatoid arthritis (RA) and bronchiectasis. Walker observed a 10fold increased prevalence of bronchiectasis in RA. The increased incidence of pulmonary disease in his study could not be explained by the greater susceptibility to infection by patients with RA because the symptoms of bronchiectasis preceded those of arthritis in the majority of the cases. Earlier reports found the prevalence of bronchiectasis in RA to be between 1 and 10%. However, with the advent of high resolution computed tomography (HRCT) of the lung, later studies reported a prevalence of 25–30%. 3 This is important as HRCT is a more sensitive method of detecting bronchiectasis, and it is generally accepted that a chest radiograph may be normal in patients with bronchiectasis. Secondly, later studies investigated principally lifelong non-smoking patients with RA as opposed to the earlier studies, which investigated patients with RA irrespective of their smoking history. Cigarette smoking, particularly heavy cigarette smoking, is associated with the development of seropositive RA. Likewise, it has been suggested that bronchiectasis may be a trigger for the development of RA. To determine if these two potential risk factors for the development of RA are distinct we used HRCT to study patients with RA to determine if there are differences in the prevalence of smoking in patients with RA and bronchiectasis.