#2-57E. Navigating Elevated Serious Infection Risk in RA-Associated Lung Disease (Arthritis Rheum, 2025)

Rheumatoid Arthritis (RA) management is increasingly complicated by severe comorbidities, especially pulmonary involvement. How significantly does RA-associated lung disease (RA-LD), encompassing interstitial lung disease (RA-ILD) and bronchiectasis (RA-BR), elevate the risk of serious infections compared to RA patients without lung involvement (RA-no LD)? This retrospective cohort study utilized the Massachusetts General Brigham Biobank data to compare RA-LD patients against matched RA-no LD comparators, calculating the propensity score–adjusted subdistribution hazard ratio (sdHR) for hospitalized infections. The study found that patients with RA-LD had a significantly higher overall serious infection incidence (55.8 vs 25.8 per 1,000 person-years; adjusted sdHR 1.60). The core finding emphasizes that RA-ILD patients constitute a high-risk group with a nearly 1.8-fold increased risk of serious infection (adjusted sdHR 1.79), spanning diverse anatomical sites (pulmonary, skin, ENT) and pathogens (viral, bacterial, fungal, mycobacterial). However, clinicians must consider the study's limitation as a retrospective design, which lacked detailed data on RA disease activity and precise lung disease severity, potentially introducing residual confounding. These compelling results provide crucial real-world evidence for tailoring infection-prevention strategies, such as prioritizing enhanced vaccination and intensifying surveillance for RA-LD patients, particularly those with ILD, to mitigate morbidity and mortality.

Citation: Zhang Q, Qi Y, Wang X, et al. Risk of Serious Infection in Patients With Rheumatoid Arthritis–Associated Interstitial Lung Disease or Bronchiectasis: A Comparative Cohort Study. Arthritis & Rheumatology. 2025. DOI: 10.1002/art.43338111.

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