Invasive fungal infections in patients with rheumatoid arthritis: an explorative analysis from the German RABBIT register
Authors' conclusion
In patients with RA, IFIs are rare but life-threatening. They occur particularly in patients who are predisposed to infection due to relevant comorbidities, a history of smoking or both. Except for GC use, the overall impact of targeted RA treatment on the risk of IFI appears to be less relevant than that of multimorbidity.
Study context
- Population
- Patients with rheumatoid arthritis (RA) in the German RABBIT register, May 2001–December 2023
- Participants
- 22,535 patients69 invasive fungal infections (IFIs)
- Outcome
- Invasive fungal infections (IFIs): incidence, characteristics, outcome and associated factors
Methodological detailsregister analysis, explorative, two-stage approach, multivariable time-dependent Cox regression
- Register analysis
- Explorative
- Two-stage approach
- Multivariable time-dependent Cox regression
Main finding
As reported in the abstract
IFI incidence and outcome
- IFIs
- 69
- Incidence rate
- 0.65/1000 patient-years
- Case fatality
- 35% (n=24)
- Pneumocystis jirovecii
- 35%
- Candida spp
- 33%
- Aspergillus spp
- 13%
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| Factors associated with IFI developmentOlder age (per 10 years) · multivariable time-dependent Cox regression | 1.36 (1.05–1.76) | |
| 0.512Hazard ratio (log scale) |
Factors associated with IFI development
| HR (95% CI) | ||
|---|---|---|
| Male sexMultivariable time-dependent Cox regression | 1.92 (1.14–3.21) | |
| Ever-smokingMultivariable time-dependent Cox regression | 2.43 (1.35–4.37) | |
| CVDMultivariable time-dependent Cox regression | 3.03 (1.80–5.10) | |
| Chronic lung diseaseMultivariable time-dependent Cox regression | 2.09 (1.21–3.61) | |
| Other autoimmune diseaseMultivariable time-dependent Cox regression | 2.11 (1.10–4.07) | |
| Use of GCsMultivariable time-dependent Cox regression | 1.17 (1.11–1.22) | |
| 0.20.5125Hazard ratio (log scale) |
Characteristics of patients with IFIs
- Mean age (years)
- 65.4
- Female
- 54%
- Ever-smokers
- 80%
- Glucocorticoid (GC) users
- 84%
- Any infection-risk associated comorbidity at hospitalisation
- 91%
Original publication
Invasive fungal infections in patients with rheumatoid arthritis: an explorative analysis from the German RABBIT register. RMD Open. Published 4 November 2025. doi:10.
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