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To assess the association of severe pulmonary arterial hypertension (PAH) with particulate matter 2.5 μm (PM2.5) and clinical data in patients with systemic autoimmune rheumatic diseases (SARDs). We used the 2003-2017 nationwide data in Taiwan to identify patients with SARDs, including systemic lupus erythematosus, rheumatoid arthritis, systemic sclerosis, dermatomyositis/polymyositis and primary Sjögren's syndrome. We identified 479 cases with severe PAH and selected controls matched (14) for age, sex, and index-year. We used