Association of Sinusitis and Upper Respiratory Tract Diseases with Incident Rheumatoid Arthritis


  • This case–control study evaluated the association between upper respiratory infections and risk of incident rheumatoid arthritis (RA). The study included 741 patients with RA and 2223 age-, sex- and electronic health history–matched controls.
  • Acute respiratory infection burden, acute and chronic sinusitis, and asthma were all associated with an increased risk of incident RA, particularly among smokers.

  • These results suggest a link between upper respiratory infections and the pathogenesis of RA. Additional research could further explore this association and establish whether the association is causal.

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Study aimed to determine whether specific respiratory tract diseases are associated with increased rheumatoid arthritis (RA) risk.


This case-control study within the Mass General Brigham Biobank matched newly diagnosed RA cases to three controls on age, sex, and electronic health record history. Study identified RA using a validated algorithm and confirmed by medical record review. Respiratory tract disease exposure required one inpatient or two outpatient codes at least two years before index date of RA clinical diagnosis or matched date.


Study identified 741 RA cases and 2,223 controls (both median age 55, 76% female). Acute sinusitis (OR 1.61, 95% CI:1.05,2.45), chronic sinusitis (OR 2.16, 95% CI:1.39,3.35), and asthma (OR 1.39, 95% CI:1.03,1.87) were associated with increased risk of RA.

Acute respiratory tract disease burden during the pre-index exposure period was also associated with increased RA risk (OR 1.30 per 10 codes, 95% CI:1.08,1.55).

Acute pharyngitis was associated with seronegative (OR 1.68, 95% CI:1.02,2.74) but not seropositive RA; chronic rhinitis/pharyngitis was associated with seropositive (OR 2.46, 95% CI:1.01,5.99) but not seronegative RA.

Respiratory tract diseases tended towards higher associations in smokers, especially >10 packyears (OR 1.52, 95% CI:1.02,2.27; p=0.10 for interaction).


Acute/chronic sinusitis and pharyngitis and acute respiratory burden increased RA risk. The mucosal paradigm of RA pathogenesis may involve the upper respiratory tract.

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