Risk of Serious Infection in Patients With Rheumatoid Arthritis-Associated Interstitial Lung Disease or...

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.