Coexistence of bronchiectasis and rheumatoid arthritis: revisited.

The presence of bronchiectasis (BR) in patients with rheumatoid arthritis (RA) has been recognized for many decades; nevertheless, little research has been undertaken in this area. It is important to recognize that BR coexistent with RA differs from the other types of BR. The purpose of this descriptive review was to delineate the epidemiology, etiology, risk factors, pulmonary function testing, imaging, prognosis and management of concomitant BR and RA. To inform our study we searched the PubMed, EMBASE, CINAHL, and MEDLINE databases, using combinations of the following key words: computed tomography, lung function tests, rheumatoid arthritis, bronchiectasis, biological agents, and interstitial lung disease. The number of published papers covering this topic is limited, but several relevant conclusions can be drawn. Patients with concomitant RA and BR have worse obstructive airways disease, increased susceptibility to recurrent pulmonary infections, faster lung function decline, and higher mortality, compared with subjects with either RA or BR alone. The use of disease-modifying anti-rheumatic drugs (both biological and non-biological) for RA in RA-BR patients imparts a further challenge in managing these patients. Although there are not any published guidelines on the management of coexisting RA-BR, we have attempted to provide such recommendations, based on the literature review and our experience.

Pneumocystis carinii pneumonia infection in a patient with known chronic mucocutaneous candidiasis.

Chronic mucocutaneous candidiasis is a disorder of the skin, nails or mucous membranes in the absence of another cause of the infection. It is also associated with autoimmune endocrinopathies in 40% of patients. It is thought to be due to a T-cell defect, although no precise mechanism has been elucidated. There have been two previous cases of Pneumocystis carinii pneumonia reported with this condition. We report a fatal case in a 34-year-old male.