Background/Purpose: Interstitial lung disease (ILD) is the second leading cause of mortality in rheumatoid arthritis (RA) but often goes underdiagnosed due to its variable clinical presentation, ranging from subclinical involvement to progressive fibrosis. Despite its impact on prognosis, data to guide evidence-based screening and treatment remain limited. Recently, The American College of Rheumatology (ACR) and the American College of Chest Physicians (CHEST) issued conditional recommendations for RA-ILD management, reflecting low-certainty evidence. The real-world application of these therapies is not well understood. This study aims to evaluate a risk factor–based screening tool for RA-ILD and compare treatment patterns between RA patients with and without ILD in a real world-setting.

Methods: We conducted a cohort study at a single academic centre including patients with RA receiving targeted therapies. Risk factors for ILD development and treatment patterns were compared between RA patients with and without ILD using chi-square and Student’s t-tests. A risk score incorporating age, sex, smoking status, RA duration, rheumatoid factor, and anti-cyclic citrullinated peptide antibodies was calculated. Receiver operating characteristic (ROC) curve analysis was used to determine optimal cut-off points for identifying patients at risk for subclinical ILD.

Results: Among 688 RA patients treated with targeted therapies, 31 (4.5%) had ILD. RA-ILD patients were older at disease onset (mean 54.9 vs. 45.2 years, p< 0.05) and more frequently smokers (48.4% vs. 14%, p< 0.05). Treatment patterns differed: RA-ILD patients more often received abatacept (32%), tocilizumab (22%), and JAK inhibitors (19%) versus patients with RA without ILD. Guideline-recommended first-line therapies for RA-ILD were infrequently used in our cohort. Three different cut-off points for the risk score were evaluated: 5 (Sens 86.7%, Spec 48.7% LR+1.7), corresponding to 228 patients (36.5%) in our cohort; 6 (Sens 76.7%, Spec 63.5% LH+ 2.1), corresponding to 59 patients (9.5%), and 7 (Sens 36.7%, Spec 90.5% LH+ 3.9), corresponding to 14 patients (2.2%).

Conclusion: The prevalence of ILD in this cohort of RA patients receiving targeted therapies was 4.5%. The risk score stratified 36% of patients as low risk, 9.5% as moderate risk, and 2.2% as high risk for subclinical RA-ILD. Risk-based screening tools may facilitate earlier detection and intervention, potentially improving clinical outcomes. Real-world treatment patterns varied from current ACR/CHEST guideline recommendations, underscoring the need for further research to individualized treatment decisions based on patient characteristics and ILD severity.

Table. Characteristics of patients with RA with and without ILD

Figure. Performance of the proposed risk score for detection of RA-ILD. Result is shown as area under the receiver operating characterize curves (AUC) with 95% confidence interval (Stata roctab). AUC: 0.75 95%CI (0.67-0.84)

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/evaluation-of-a-screening-tool-for-identifying-risk-of-subclinical-interstitial-lung-disease-in-rheumatoid-arthritis-patients-treated-with-targeted-therapies/