RA-ILD at Higher Risk for Serious Infection and Death Save

A prospective, multicenter study from Spain has demonstrated higher rates of mortality and serious infection in rheumatoid arthritis–associated interstitial lung disease (RA-ILD) patients.

This multicenter prospective cohort was enrolled between 2015 to 2023. The primary outcomes were serious infection and mortality rates over time. Serious infections were defined as requiring antibiotic therapy and one of the following outcomes: death, a life-threatening condition, hospitalization, disability or permanent damage, congenital anomaly/birth defect, need for an intervention to prevent permanent impairment or damage. 

They followed 148 patients RA-ILD patients for a median 56.7 months (699.3 person-years). At least 1 serious infection was seen in 96% of patients with a serious infection incidence rate of 52.6 per 100 person-years. (Editor’s note: this is substantially higher than the commonly reported SIE rate in RA during the pre-biologic era of 3-9 per 100 patient years)

Patients with ILD are known to have higher mortality rates and in this study, 48 (32%) RA-ILD patients died, with two-thirds (65%) dying from serious infection. Respiratory infections were the most common, and were attributed to SARS CoV-2, Streptococcus pneumoniae, Pseudomonas aeruginosa, and influenza A.

In this RA-ILD cohort, predictors of serious infection and death were age, inflammatory activity, corticosteroid and immunosuppressant use. 

In RA-ILD patients serious infections are common, occur early, may be recurrent or even fatal.