{"doi":"10.1002/art.43338","title":"Risk of Serious Infection in Patients With Rheumatoid Arthritis–Associated Interstitial Lung Disease or Bronchiectasis: A Comparative Cohort Study","abstract":"<jats:sec>\n                    <jats:title>Objective</jats:title>\n                    <jats:p>To investigate the association between rheumatoid arthritis–associated lung disease (RA‐LD) and serious infection risk.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods</jats:title>\n                    <jats:p>We conducted a retrospective cohort study using the Massachusetts General Brigham Biobank (Boston, MA, USA), comparing RA‐LD with patients with RA without lung disease (RA‐no LD), matched by age, sex, and RA duration. Cases of RA‐LD were 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). The primary outcome was serious infection. Incidence rates and propensity score–adjusted subdistribution hazard ratios (sdHRs) were calculated using Fine and Gray models to account for competing risk of death.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Results</jats:title>\n                    <jats:p>\n                      Among 221 patients with RA‐LD (151 RA‐ILD and 70 RA‐BR) and 980 RA‐no LD comparators, RA‐LD had a significantly higher serious infection risk compared with RA‐no LD comparators (55.8 vs 25.8 per 1,000 person‐years; sdHR 1.60; 95% confidence interval [CI] 1.20–2.12). The increased risk remained significant for those with RA‐ILD (sdHR 1.79; 95% CI 1.33–2.41) but not for RA‐BR (sdHR 1.19; 95% CI 0.72–1.97). Anatomic sites of infection that were more common in RA‐LD included pulmonary, skin and soft tissue, and ear, nose, and throat; RA‐LD was associated with various pathogen types, including virus, bacteria, fungus, and mycobacteria. Specific pathogens with higher frequency in cases of RA‐LD, particularly among RA‐BR, included influenza virus, respiratory syncytial virus,\n                      <jats:italic>Staphylococcus</jats:italic>\n                      ,\n                      <jats:italic>Pseudomonas</jats:italic>\n                      , and nontuberculous mycobacteria.\n                    </jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion</jats:title>\n                    <jats:p>RA‐LD, particularly RA‐ILD, is associated with a significant increased risk of serious infection across anatomic sites and diverse pathogen types. RA‐BR is associated with increased pulmonary infections. Prospective studies and trials are needed to clarify optimal approaches to treat patients with RA‐LD and reduce infection risk.</jats:p>\n                    <jats:p>\n                      <jats:boxed-text content-type=\"graphic\" position=\"anchor\">\n                        <jats:graphic xmlns:xlink=\"http://www.w3.org/1999/xlink\" mimetype=\"image/png\" position=\"anchor\" specific-use=\"enlarged-web-image\" xlink:href=\"graphic/art43338-gra-0001-m.png\">\n                          <jats:alt-text>image</jats:alt-text>\n                        </jats:graphic>\n                      </jats:boxed-text>\n                    </jats:p>\n                  </jats:sec>","journal":"Arthritis &amp; Rheumatology","year":2026,"id":609002,"datarank":0.25895443334676876,"base_score":1.6094379124341003,"endowment":1.6094379124341003,"self_citation_contribution":0.24141568686511508,"citation_network_contribution":0.01753874648165366,"self_endowment_contribution":0.24141568686511508,"citer_contribution":0.01753874648165366,"corpus_percentile":null,"corpus_rank":null,"citation_count":4,"citer_count":3,"citers_with_citation_signal":1,"citers_with_endowment":1,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":703818,"name":"英士 宮崎","orcid":"0000-0002-2178-214X","position":1,"is_corresponding":false},{"id":226447,"name":"Xiaosong Wang","orcid":"0000-0002-3840-5658","position":2,"is_corresponding":false},{"id":1564840,"name":"Gregory C. McDermott","orcid":null,"position":3,"is_corresponding":false},{"id":1230309,"name":"Sung Hae Chang","orcid":"0000-0002-7980-7194","position":4,"is_corresponding":false},{"id":1564841,"name":"Mark Chaballa","orcid":null,"position":5,"is_corresponding":false},{"id":1564842,"name":"Vadim Khaychuk","orcid":null,"position":6,"is_corresponding":false},{"id":1213180,"name":"Misti L. Paudel","orcid":"0000-0002-8361-0650","position":7,"is_corresponding":false},{"id":236764,"name":"Jeffrey A. Sparks","orcid":"0000-0002-5556-4618","position":8,"is_corresponding":false},{"id":1376860,"name":"Qianru Zhang","orcid":"0000-0001-9615-5768","position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"Risk of Serious Infection in Patients With Rheumatoid Arthritis–Associated Interstitial Lung Disease or Bronchiectasis: A Comparative Cohort Study","abstract":"<jats:sec>\n                    <jats:title>Objective</jats:title>\n                    <jats:p>To investigate the association between rheumatoid arthritis–associated lung disease (RA‐LD) and serious infection risk.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods</jats:title>\n                    <jats:p>We conducted a retrospective cohort study using the Massachusetts General Brigham Biobank (Boston, MA, USA), comparing RA‐LD with patients with RA without lung disease (RA‐no LD), matched by age, sex, and RA duration. Cases of RA‐LD were 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). The primary outcome was serious infection. Incidence rates and propensity score–adjusted subdistribution hazard ratios (sdHRs) were calculated using Fine and Gray models to account for competing risk of death.</jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Results</jats:title>\n                    <jats:p>\n                      Among 221 patients with RA‐LD (151 RA‐ILD and 70 RA‐BR) and 980 RA‐no LD comparators, RA‐LD had a significantly higher serious infection risk compared with RA‐no LD comparators (55.8 vs 25.8 per 1,000 person‐years; sdHR 1.60; 95% confidence interval [CI] 1.20–2.12). The increased risk remained significant for those with RA‐ILD (sdHR 1.79; 95% CI 1.33–2.41) but not for RA‐BR (sdHR 1.19; 95% CI 0.72–1.97). Anatomic sites of infection that were more common in RA‐LD included pulmonary, skin and soft tissue, and ear, nose, and throat; RA‐LD was associated with various pathogen types, including virus, bacteria, fungus, and mycobacteria. Specific pathogens with higher frequency in cases of RA‐LD, particularly among RA‐BR, included influenza virus, respiratory syncytial virus,\n                      <jats:italic>Staphylococcus</jats:italic>\n                      ,\n                      <jats:italic>Pseudomonas</jats:italic>\n                      , and nontuberculous mycobacteria.\n                    </jats:p>\n                  </jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion</jats:title>\n                    <jats:p>RA‐LD, particularly RA‐ILD, is associated with a significant increased risk of serious infection across anatomic sites and diverse pathogen types. RA‐BR is associated with increased pulmonary infections. Prospective studies and trials are needed to clarify optimal approaches to treat patients with RA‐LD and reduce infection risk.</jats:p>\n                    <jats:p>\n                      <jats:boxed-text content-type=\"graphic\" position=\"anchor\">\n                        <jats:graphic xmlns:xlink=\"http://www.w3.org/1999/xlink\" mimetype=\"image/png\" position=\"anchor\" specific-use=\"enlarged-web-image\" xlink:href=\"graphic/art43338-gra-0001-m.png\">\n                          <jats:alt-text>image</jats:alt-text>\n                        </jats:graphic>\n                      </jats:boxed-text>\n                    </jats:p>\n                  </jats:sec>","is_dataset_classified":null,"base_score":1.6094379124341003,"endowment":1.6094379124341003,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"40708472","pmcid":null,"openalex_id":"https://openalex.org/W4412654917","authors":[],"funders":[{"funder_name":"National Institute of Arthritis and Musculoskeletal and Skin Diseases","grant_id":"P30 AR070253","title":null},{"funder_name":"National Institute of Arthritis and Musculoskeletal and Skin Diseases","grant_id":"P30 AR072577","title":null},{"funder_name":"National Institute of Arthritis and Musculoskeletal and Skin Diseases","grant_id":"R01 AR077607","title":null},{"funder_name":"National Institute of Arthritis and Musculoskeletal and Skin Diseases","grant_id":"R01 AR080659","title":null},{"funder_name":"National Heart, Lung, and Blood Institute","grant_id":"R01 HL155522","title":null},{"funder_name":"Gordon and Llura Gund Foundation","grant_id":"","title":null},{"funder_name":"ARTHFN","grant_id":"","title":null},{"funder_name":"Arthritis Foundation","grant_id":"","title":null},{"funder_name":"R. Bruce and Joan M. Mickey Research Scholar Fund","grant_id":"","title":null}],"total_grants":9,"fwci":3.0353,"citation_percentile":0.91779616,"influential_citations":0,"citation_trend":[{"year":2025,"count":1},{"year":2026,"count":3}],"oa_status":"bronze","license":"http://doi.wiley.com/10.1002/tdm_license_1.1","oa_locations":[{"url":"https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/art.43338","host_type":"journal"},{"url":"https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/art.43338","host_type":"publisher"},{"url":"https://acrjournals.onlinelibrary.wiley.com/doi/pdf/10.1002/art.43338","host_type":"publisher"},{"url":"https://acrjournals.onlinelibrary.wiley.com/doi/full-xml/10.1002/art.43338","host_type":"publisher"},{"url":"https://doi.org/10.1002/art.43338","host_type":"journal"},{"url":"https://pubmed.ncbi.nlm.nih.gov/40708472","host_type":"repository"}],"fields_of_study":["Interstitial Lung Diseases and Idiopathic Pulmonary Fibrosis","Rheumatoid Arthritis Research and Therapies","Inflammatory Myopathies and Dermatomyositis"],"mesh_terms":[],"keywords":["Medicine","Internal medicine","Bronchiectasis","Rheumatoid arthritis","Interstitial lung disease","Nontuberculous mycobacteria","Cohort","Gastroenterology","Lung","Tuberculosis","Pathology"],"sdg_mappings":[{"sdg_number":0,"sdg_label":"Good health and well-being"}],"linked_datasets":[],"clinical_trials":[],"software_tools":[],"database_accessions":[],"source":"live","citation_network_status":"fetched"},"created_at":"2026-07-31T01:54:29.779804Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}