To evaluate the relative risk of respiratory tract disease in rheumatoid arthritis （RA） patients treated with tofacitinib.

From PubMed, Embase, Web of Science, and Cochrane Library databases, the double-blind randomized controlled trials （RCTs） of RA patients who treated with tofacitinib were searched, and the search time limit was from the establishment of the databases to September 2022. The Cochrane risk of bias tool was used to evaluate the quality of the included trials, the RevMan 5.3 software was used for statistical analysis, and the Mantel-Haenszel fixed-effects method was used for relative risk （RR） comparison to evaluate the results.

Fourteen double-blind RCTs were included, with a total of 6 372 RA patients. The results of meta-analysis showed that compared with the control group, the risk of lower respiratory tract infection was significantly increased in the tofacitinib group （RR= 2.32, 95% CI：1.27 to 4.24，P=0.006）, while the risk of pulmonary embolism was significantly reduced （RR=0.16, 95% CI：0.03 to 0.94, P=0.04）. There was no significant difference in the risk of upper respiratory tract infection, influenza, pneumonia, opportunistic respiratory tract infection, and other non-infectious respiratory adverse events between the tofacitinib group and the control group （P>0.05）.

Tofacitinib used for the treatment of RA will increase the risk of lower respiratory tract infection, but has no correlation with the risk of other respiratory tract diseases.