Related Experiment Video
Updated: Sep 14, 2025
Preliminary Study on Acupuncture Combined with Grain-sized Moxibustion for Treating Rheumatoid Arthritis with Finger Joint Pain
Published on: May 16, 2025
Risk of Serious Infection in Patients With Rheumatoid Arthritis-Associated Interstitial Lung Disease or
Qianru Zhang1, Ying Qi2, Xiaosong Wang2
1Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, and Department of Rheumatology and Immunology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
Objective:
To investigate the association between rheumatoid arthritis-associated lung disease (RA-LD) and serious infection risk.
Methods:
We conducted a retrospective cohort study using the Massachusetts General Brigham Biobank (Boston, MA, USA), comparing RA-LD with patients with RA without lung disease (RA-no LD), matched by age, sex, and RA duration. Cases of RA-LD were verified by medical record review and chest imaging for clinically apparent RA-associated interstitial lung disease (RA-ILD) and/or RA-associated bronchiectasis (RA-BR). The primary outcome was serious infection. Incidence rates and propensity score-adjusted subdistribution hazard ratios (sdHRs) were calculated using Fine and Gray models to account for competing risk of death.
Results:
Among 221 patients with RA-LD (151 RA-ILD and 70 RA-BR) and 980 RA-no LD comparators, RA-LD had a significantly higher serious infection risk compared with RA-no LD comparators (55.8 vs 25.8 per 1,000 person-years; sdHR 1.60; 95% confidence interval [CI] 1.20-2.12). The increased risk remained significant for those with RA-ILD (sdHR 1.79; 95% CI 1.33-2.41) but not for RA-BR (sdHR 1.19; 95% CI 0.72-1.97). Anatomic sites of infection that were more common in RA-LD included pulmonary, skin and soft tissue, and ear, nose, and throat; RA-LD was associated with various pathogen types, including virus, bacteria, fungus, and mycobacteria. Specific pathogens with higher frequency in cases of RA-LD, particularly among RA-BR, included influenza virus, respiratory syncytial virus, Staphylococcus, Pseudomonas, and nontuberculous mycobacteria.
Conclusion:
RA-LD, particularly RA-ILD, is associated with a significant increased risk of serious infection across anatomic sites and diverse pathogen types. RA-BR is associated with increased pulmonary infections. Prospective studies and trials are needed to clarify optimal approaches to treat patients with RA-LD and reduce infection risk.
Insights
Rheumatoid arthritis-associated lung disease (RA-LD) significantly increases serious infection risk, especially RA-ILD. RA-LD patients face higher rates of diverse infections, necessitating further research for optimal management strategies.
Area of Science:
- Rheumatology
- Infectious Diseases
- Pulmonology
Background:
- Rheumatoid arthritis (RA) can manifest with lung disease (RA-LD), encompassing interstitial lung disease (RA-ILD) and bronchiectasis (RA-BR).
- The impact of RA-LD on serious infection risk remains incompletely understood.
Purpose of the Study:
- To investigate the association between rheumatoid arthritis-associated lung disease (RA-LD) and the risk of serious infections.
- To differentiate infection risks between RA-ILD and RA-BR subtypes.
Main Methods:
- Retrospective cohort study utilizing the MGB Biobank.
- Comparison of 221 RA-LD patients (151 RA-ILD, 70 RA-BR) with 980 RA-no LD controls, matched for age, sex, and RA duration.
- Serious infection as the primary outcome, analyzed using propensity score-adjusted subdistribution hazard ratios (sdHR) with Fine and Gray models.
Main Results:
- RA-LD patients exhibited a significantly higher risk of serious infections (sdHR 1.60) compared to RA-no LD controls.
- RA-ILD was strongly associated with increased serious infection risk (sdHR 1.79), while RA-BR showed a non-significant trend (sdHR 1.19).
- Infections in RA-LD spanned multiple sites (pulmonary, skin, ENT) and pathogens (viral, bacterial, fungal, mycobacterial), with specific pathogens like Staphylococcus and Pseudomonas being more frequent.
Conclusions:
- Rheumatoid arthritis-associated lung disease, particularly RA-ILD, is linked to a substantial increase in serious infections across various sites and pathogen types.
- RA-BR is specifically associated with an increased risk of pulmonary infections.
- Further prospective studies are crucial to guide optimal treatment strategies for RA-LD patients and mitigate infection risks.
Related Concept Videos
01:27Chronic Obstructive Pulmonary Disease-IV: Assessement and Diagnostic Studies
Medical History
01:30Pneumonia III: Complications and Assessment
01:22Chronic Obstructive Pulmonary Disease
Smoking is a primary risk factor for COPD, with over 80% of patients having a history of it. Patients typically experience progressive dyspnea or labored breathing, frequent coughing, and recurrent pulmonary infections. Many eventually succumb to respiratory failure, characterized by...
01:30Pneumonia I: Introduction
Risk Factors
Various factors influence the likelihood of developing pneumonia. Age plays a crucial role, with infants, children under two, and individuals over 65 at increased risk due to their...
01:26Factors Affecting the Risk of Infection
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin...
01:26COPD: Management Using Bronchodilators and Corticosteroids