Hospitalization risk in patients with rheumatoid arthritis-associated interstitial lung disease or bronchiectasis: A...

To investigate hospitalization risk and identify factors associated with respiratory hospitalization in rheumatoid arthritis-associated lung disease (RA-LD).

We conducted a retrospective cohort study using the Mass General Brigham Biobank (Boston, Massachusetts), comparing RA-LD cases to matched RA comparators without lung disease (RA-no LD). RA-LD was 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). A subset had genotyping performed for the MUC5B promoter variant. The co-primary outcomes were overall and respiratory hospitalizations. Incidence rate ratios (IRRs) with 95% confidence intervals (CI) were estimated using multivariable Poisson regression models, comparing RA-LD, RA-ILD, and RA-BR cases vs. RA-no LD comparators, adjusting for covariates by a propensity score.

We analyzed 221 RA-LD cases (151 RA-ILD and 70 RA-BR) and 980 RA-no LD comparators. RA-LD, including RA-ILD and RA-BR, had higher risks of overall hospitalization (adjusted IRR 1.73, 95%CI 1.57-1.91) and respiratory hospitalization (adjusted IRR 5.13, 95%CI 3.80-6.94). RA-ILD also had increased risk of intensive care unit (ICU) admissions (adjusted IRR 1.99, 95%CI 1.81-2.18). The MUC5B promoter variant and glucocorticoid use were each associated with higher respiratory hospitalization risk, whereas more frequent clinic visits and female sex were associated with lower risk.

RA-ILD and RA-BR were each associated with markedly higher risks of overall and respiratory hospitalization than RA-no LD comparators. Factors including the MUC5B promoter variant and glucocorticoid use may place patients at higher risk for acute care utilization. These findings support early risk stratification and proactive monitoring to guide personalized RA-LD management.