Rheumatoid Arthritis-Linked Lung Disease Significantly Raises Risk of Death, Finds Study
USA: Individuals with rheumatoid arthritis (RA) who also suffer from associated lung conditions face a significantly higher risk of death—particularly from respiratory and infection-related causes—according to a new study published in the journal Rheumatology. The research was led by Dr. Qianru Zhang and her team at the Division of Rheumatology, Inflammation, and Immunity from the Brigham and Women’s Hospital in Boston.
The study assessed mortality risks among patients with RA-associated interstitial lung disease (RA-ILD) or bronchiectasis (RA-BR), collectively termed RA-associated lung disease (RA-LD), compared to those with RA but no lung involvement (RA-no LD). Using retrospective data from the Mass General Brigham Biobank, the researchers analyzed 221 individuals with RA-LD and 980 matched comparators without lung disease, considering variables like age, sex, RA duration, and time of diagnosis.
The following were the key findings:
- The overall mortality rate among RA-LD patients was more than twice that of RA patients without lung disease (34.0 vs 13.1 deaths per 1,000 person-years).
- The hazard ratio (HR) for all-cause mortality in RA-LD patients was 1.97.
- Respiratory-related deaths were significantly more common in RA-LD patients, particularly in those with RA-ILD.
- The risk of respiratory mortality in RA-ILD patients was nearly seven times higher (sdHR 6.68) than in RA-no LD patients.
- Mortality due to lung infections in RA-LD patients was over three times higher (sdHR 3.33) than in the comparator group.
- Patients with RA-associated bronchiectasis (RA-BR) had a higher rate of cancer-related deaths (8.6 vs 2.3 per 1,000 person-years).
- The subdistribution hazard ratio (sdHR) for cancer mortality in RA-BR patients was 2.89.
- Infection-related deaths occurred in 7% of RA-LD patients, compared to 3% among those without lung disease.
The results suggest that lung involvement in RA not only contributes to respiratory failure but may also weaken the body’s defense against infections.
These findings highlight the importance of recognizing and managing lung complications in individuals with rheumatoid arthritis. The authors suggest that earlier diagnosis, more effective respiratory therapies, aggressive infection control strategies, and vigilant cancer screening may help reduce the elevated mortality risks seen in this patient group.
Although the study’s retrospective design limits its ability to confirm causality, it provides crucial insights into the burden of RA-associated lung disease. The researchers call for larger prospective studies to further validate these findings and support the development of targeted interventions.
As RA patients continue to live longer due to advances in rheumatologic care, the study emphasizes the need to address the often-overlooked pulmonary complications that can drastically alter outcomes.
Reference:
Zhang, Q., Qi, Y., Wang, X., McDermott, G. C., Chang, S. H., Chaballa, M., Khaychuk, V., Paudel, M. L., & Sparks, J. A. Risk of total and cause-specific mortality in patients with rheumatoid arthritis-associated interstitial lung disease or bronchiectasis. Rheumatology. https://doi.org/10.1093/rheumatology/keaf380
