Clinical features, management and outcome of rheumatoid arthritis patients with pulmonary involvement in intensive care unit: a retrospective observational case series study

Rheumatoid arthritis (RA) is one of the rheumatic diseases with life-threatening complications that may require admission to the intensive care unit (ICU). In this study, we aimed to evaluate the clinical features, management and factors that may influence the course and prognosis of RA patients with pulmonary involvement in ICU. A retrospective observational study was conducted and the medical records of RA patients with pulmonary involvement who admitted to ICU in a large tertiary hospital from January 2014 to May 2025 were reviewed. A total of twenty patients were enrolled during the study period. The leading causes of ICU admission were interstitial lung disease with respiratory failure, followed by severe pneumonia. Eight patients died within 30 days after admission to ICU. Infections led to a fatal outcome in most cases. Poor prognostic factors in the non-survival group were lower oxygenation index, renal dysfunction, higher SOFA scores, invasive mechanical ventilation and vasoactive medication requirement. The study emphasizes RA patients in ICU have a rather poor prognosis, particularly in the presence of pulmonary involvement. Early and accurate diagnosis of critical conditions, along with timely and appropriate interventions, is essential to reduce mortality.