RA associated lung disease patients have increased risk of Infection: Study

A new study published in the journal of Arthritis & Rheumatology revealed that patients with rheumatoid arthritis-associated lung disease (RA-ILD) face a significantly higher risk of serious infections when compared with those with rheumatoid arthritis (RA) alone especially when bronchiectasis is present.

This study examined medical data from the MGB Biobank to explore the relationship between lung complications in rheumatoid arthritis and infection risk. This research compared 221 patients diagnosed with RA-LD (151 with interstitial lung disease and 70 with bronchiectasis) against 980 matched RA patients without lung disease (RA-no LD). The groups were matched by age, sex, and duration of RA to ensure balanced comparisons.

Lung disease diagnoses were confirmed through detailed reviews of medical records and chest imaging. This research focused on serious infections as the main outcome, by analyzing the occurrence rates and adjusting for potential confounders like mortality risk.

The data found individuals with RA-LD to face serious infections at a rate of 55.8 per 1,000 person-years, more than double the rate seen in those without lung disease (25.8 per 1,000 person-years). After statistical adjustment using Fine and Gray models, the risk remained notably higher for RA-LD patients, with a subdistribution hazard ratio (sdHR) of 1.60 (95% confidence interval [CI], 1.20–2.12).

When broken down by lung disease subtype, the results showed that RA-ILD carried the greatest infection risk, with an sdHR of 1.79 (95% CI, 1.33–2.41). Also, patients with RA-associated bronchiectasis did not exhibit a statistically significant increase in overall infection risk (sdHR 1.19, 95% CI, 0.72–1.97).

In RA-LD patients, the most commonly affected sites were the lungs, skin and soft tissues, and the ear, nose, and throat. Infections were caused by a diverse range of pathogens, including viruses, bacteria, fungi, and mycobacteria. Particularly among those with RA-BR, there were higher frequencies of infections caused by influenza virus, respiratory syncytial virus (RSV), Staphylococcus, Pseudomonas, and nontuberculous mycobacteria.

Overall, this findings emphasized a pressing need for proactive infection surveillance and prevention strategies in RA patients with lung involvement. These result suggest that RA-associated lung disease, especially interstitial lung disease, predisposes patients to a broad spectrum of serious infections.

Source:

Zhang, Q., Qi, Y., Wang, X., McDermott, G. C., Chang, S. H., Chaballa, M., Khaychuk, V., Paudel, M. L., & Sparks, J. A. (2025). Risk of serious infection in patients with rheumatoid arthritis-associated interstitial lung disease or bronchiectasis: A comparative cohort study. Arthritis & Rheumatology, art.43338. https://doi.org/10.1002/art.43338