{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T06:31:09Z","timestamp":1787725869029,"version":"build-2784847793"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Rheumatoid arthritis-associated interstitial lung disease (RA-ILD) is one of the most severe extra-articular complications of rheumatoid arthritis (RA). Although tumor necrosis factor-\u03b1 (TNF-\u03b1) plays a central role in RA pathogenesis, its relationship with RA-ILD remains uncertain. This study aimed to investigate the association between serum TNF-\u03b1 levels and RA-ILD, with a focus on sex-stratified patterns.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a cross-sectional study that initially included 1,191 consecutive RA inpatients at Xingtai People\u2019s Hospital between March 2022 and December 2024. Clinical and laboratory data were extracted from electronic medical records. RA-ILD was diagnosed using high-resolution computed tomography, with subtypes classified by consensus. Multivariable logistic regression and generalized additive models were used to assess the association of TNF-\u03b1 with RA-ILD. Serum TNF-\u03b1 was natural log-transformed (ln) to improve linearity and reduce the influence of extreme values.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      After exclusions, 790 patients were included in the final analysis, of whom 149 (18.86%) had RA-ILD, with a higher prevalence in males than in females (30.68%\n                      <jats:italic>vs<\/jats:italic>\n                      15.47%). In sex-stratified analyses, after adjusting for age, disease duration, rheumatoid factor, and anti-citrullinated protein antibody in both sexes, and additionally adjusting for smoking in males, serum TNF-\u03b1 was associated with RA-ILD in females (highest\n                      <jats:italic>vs<\/jats:italic>\n                      lowest tertile: OR\u00a0=\u00a01.96, 95% CI: 1.10 \u2013 3.48;\n                      <jats:italic>P<\/jats:italic>\n                      for trend &amp;lt; 0.01). This association followed a nonlinear pattern, with an exploratory inflection point above which elevated TNF-\u03b1 showed a positive association with increased odds of RA-ILD. In males, no statistically significant association was observed across all models. However, the formal sex \u00d7ln(TNF-\u03b1) interaction term was not statistically significant (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.08).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In sex-stratified analyses, serum TNF-\u03b1 was associated with RA-ILD in females, exhibiting a nonlinear relationship with a potential inflection point; no statistically significant association was observed in males. However, as the interaction testing did not confirm a statistically significant sex difference, these findings are exploratory and warrant further prospective validation in larger cohorts.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1881556","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T06:02:53Z","timestamp":1787724173000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Association between serum tumor necrosis factor-alpha levels and rheumatoid arthritis-associated interstitial lung disease: a cross-sectional study"],"prefix":"10.3389","volume":"17","author":[{"given":"Xiaoli","family":"Li","sequence":"first","affiliation":[{"name":"Department of Rheumatology, Xingtai People\u2019s Hospital","place":["Xingtai, Hebei, China"]},{"name":"Hebei Province Xingtai People\u2019s Hospital Postdoctoral Workstation","place":["Xingtai, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lina","family":"Leng","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Xingtai People\u2019s Hospital","place":["Xingtai, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaorong","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Xingtai People\u2019s Hospital","place":["Xingtai, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinfeng","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Xingtai People\u2019s Hospital","place":["Xingtai, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinfang","family":"Shang","sequence":"additional","affiliation":[{"name":"Department of Radiology, Xingtai People\u2019s Hospital","place":["Xingtai, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shusen","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, Xingtai People\u2019s Hospital","place":["Xingtai, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dengxiang","family":"Liu","sequence":"additional","affiliation":[{"name":"Hebei Provincial Key Laboratory of Portal Hypertension and Cirrhosis, Xingtai People\u2019s Hospital","place":["Xingtai, Hebei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuhua","family":"Qiao","sequence":"additional","affiliation":[{"name":"Department of Surgical Urology, Xingtai People\u2019s Hospital","place":["Xingtai, Hebei, 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