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First, a detailed case description, including a comparison of cases by infection outcome, was conducted using routine register data and hospital discharge letters. Second, a multivariable time-dependent Cox regression model was fitted to analyse associations with IFI development using routine register data only.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 22 535 patients with RA, 69 IFIs occurred (incidence rate: 0.65\/1000 patient-years), with a case fatality of 35% (n=24). Causative pathogens were\n                      <jats:italic>Pneumocystis jirovecii<\/jats:italic>\n                      (35%),\n                      <jats:italic>Candida<\/jats:italic>\n                      spp (33%) and\n                      <jats:italic>Aspergillus<\/jats:italic>\n                      spp (13%).\n                    <\/jats:p>\n                    <jats:p>Patients with IFIs were on average 65.4 years old; 54% were female, 80% ever-smokers, 84% glucocorticoid (GC) users and 91% had any infection-risk associated comorbidity at hospitalisation. IFI development was associated with older age (HR 1.36 per 10 years (95% CI 1.05 to 1.76)), male sex (HR 1.92 (95% CI 1.14 to 3.21)), ever-smoking (HR 2.43 (95% CI 1.35 to 4.37)), cardiovascular disease (HR 3.03 (95% CI 1.80 to 5.10)), chronic lung disease (HR 2.09 (95% CI 1.21 to 3.61)), other autoimmune disease (HR 2.11 (95% CI 1.10 to 4.07)), and the use of GCs (HR 1.17 (95% CI 1.11 to 1.22)).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rmdopen-2025-005961","type":"journal-article","created":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T07:05:30Z","timestamp":1762326330000},"page":"e005961","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Invasive fungal infections in patients with rheumatoid arthritis: an explorative analysis from the German RABBIT register"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-3458-6764","authenticated-orcid":false,"given":"Alina","family":"Purschke","sequence":"first","affiliation":[{"name":"Epidemiology and Health Services Research, German Rheumatology Research Center, Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vera","family":"Zietemann","sequence":"additional","affiliation":[{"name":"Epidemiology and Health Services Research, German Rheumatology Research Center, Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Herzer","sequence":"additional","affiliation":[{"name":"Medical Care Center Medicover, Munich, Germany"},{"name":"Scientific Advisory Board RABBIT, Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cornelia","family":"K\u00fchne","sequence":"additional","affiliation":[{"name":"Rheumatological practice, Haldensleben, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Marycz","sequence":"additional","affiliation":[{"name":"Rheumatological practice, Amberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uta","family":"Syrbe","sequence":"additional","affiliation":[{"name":"Rheumatological practice, Berlin, Germany"},{"name":"Med. Department of Gastroenterology, Infectiology and Rheumatology, Charit\u00e9 University Hospital Berlin, Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian","family":"Richter","sequence":"additional","affiliation":[{"name":"Epidemiology and Health Services Research, German Rheumatology Research Center, Berlin, Germany"},{"name":"SHIP-KEF: Clinical-Epidemiological Research, University Medicine Greifswald Institute of Community Medicine, Greifswald, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6233-022X","authenticated-orcid":false,"given":"Anja","family":"Strangfeld","sequence":"additional","affiliation":[{"name":"Epidemiology and Health Services Research, German Rheumatology Research Center, Berlin, Germany"},{"name":"Department of Rheumatology and Clinical Immunology, Charit\u00e9 University Hospital Berlin, Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,11,4]]},"reference":[{"key":"2026010700552618000_11.4.e005961.1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(23)00692-8"},{"key":"2026010700552618000_11.4.e005961.2","unstructured":"WHO . Fungal priority pathogens list to guide research, development and public health action. 2022. 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