Respiratory syncytial virus infection in patients with rheumatoid arthritis: Does disease status and immunosuppression alter clinical course, severity, and hospitalization risk?

Respiratory syncytial virus (RSV) is an increasingly recognized cause of severe respiratory infection in older adults, particularly those with underlying comorbidities and immunosuppression. However, the specific burden of RSV disease in patients with rheumatoid arthritis (RA) and other systemic autoimmune rheumatic diseases (SARD) remains incompletely characterized. This narrative review synthesizes current evidence on RSV epidemiology in immunocompromised populations, pathophysiological mechanisms underlying increased susceptibility in RA, risk stratification approaches, clinical presentation and complications, prevention strategies including recently approved vaccines (Arexvy, Abrysvo, mResvia), and clinical management recommendations. Recent data demonstrate that RA patients have substantially higher hospitalization rates (approximately 54%) compared with immunocompetent older adults (6–8%), with frailty emerging as the strongest independent predictor of severe infection (adjusted odds ratio 5.15). Contemporary evidence supports the benefit of RSV vaccination in older adults; however, reduced immunogenicity has been documented in patients receiving targeted immunosuppressive therapies. This review emphasizes individualized risk assessment, optimization of immunosuppression, timely vaccination with enhanced monitoring in high-risk subgroups, early clinical recognition of RSV infection, and evidence-based management approaches. By integrating clinical epidemiology with preventive and therapeutic strategies, contemporary practice can substantially reduce RSV-related complications in this vulnerable population.