TY - JOUR T1 - RA autoantibodies as predictors of rheumatoid arthritis in non-cystic fibrosis bronchiectasis patients JF - European Respiratory Journal JO - Eur Respir J SP - 1082 LP - 1085 DO - 10.1183/09031936.00064014 VL - 44 IS - 4 AU - Elizabeth Perry AU - Chris Stenton AU - Clive Kelly AU - Paul Eggleton AU - David Hutchinson AU - Anthony De Soyza Y1 - 2014/10/01 UR - http://erj.ersjournals.com/content/44/4/1082.abstract N2 - To the Editor:The mechanisms underlying the strong association between rheumatoid arthritis (RA) and bronchiectasis were recently reviewed [1]. A literature review highlighted 289 reports of bronchiectasis associated with RA, with the respiratory symptoms preceding joint symptoms in 90% of the reports [2], strongly suggesting that the processes in bronchiectasis predispose to RA.Rheumatoid factor (RF) and anti-cyclic citrullinated antibody (anti-CCP) are integral in the initiation of RA. A Danish study (n=9712) observed that the baseline IgM RF was predictive of a significant, six-fold increased risk of RA development if the RF was two- to four-fold above the normal range [3]. Likewise, a strongly positive anti-CCP test significantly increases the risk of RA (OR 25) [4].Two studies have investigated RF in bronchiectasis [5, 6] with no studies to date investigating anti-CCP. In our BRAC RA (Bronchiectasis, Asthma, Control, Rheumatoid Arthritis) study, a prospective, multicentre, case–control, observational study was conducted to determine the relationship between bronchiectasis and RF and anti-CCP. Recruitment was completed over 12 months using identical methodology and reviewed by the same researcher (E. Perry) with full ethical approval (Integrated Research Application System approval number 12324; Health Research Authority, London, UK). All recruited bronchiectasis patients were under respiratory specialist care, and had high-resolution computed tomography (HRCT) evidence of bronchiectasis and a history of two or more respiratory infections per year. Key exclusion criteria included inflammatory arthritis, tuberculosis or other forms of lung disease. Cystic fibrosis was excluded using genotyping and sweat testing following British Thoracic Society guidelines. Asthma patients were identified from a database where the diagnosis had been confirmed by expert review. Healthy controls were matched with the asthma patients, where possible, for smoking history, age and sex. Anti-CCP measurement was undertaken by ELISA assays including … ER -