Real-world screening for interstitial lung disease in rheumatoid arthritis: the value of spirometry, DLCO, and clinical risk factors
References
- BONGARTZ T., NANNINI C., MEDINA-VELASQUEZ Y.F., ACHENBACH S.J., CROWSON C.S., RYU J.H., et al. Incidence and mortality of interstitial lung disease in rheumatoid arthritis: a population-based study. Arthritis Rheum. 2010;62(6):1583–91.
- ASSAYAG D., LEE J.S., KING T.E., JR. Rheumatoid arthritis associated interstitial lung disease: a review. Medicina (B Aires). 2014;74(2):158–65.
- KELLY C.A., NISAR M., ARTHANARI S., CARTY S., WOODHEAD F.A., PRICE-FORBES A., et al. Rheumatoid arthritis related interstitial lung disease - improving outcomes over 25 years: a large multicentre UK study. Rheumatology (Oxford). 2021;60(4):1882–90.
- KIM E.J., ELICKER B.M., MALDONADO F., WEBB W.R., RYU J.H., VAN UDEN J.H., et al. Usual interstitial pneumonia in rheumatoid arthritis-associated interstitial lung disease. Eur Respir J. 2010;35(6):1322–8.
- NAKAMURA T., JINTA T., KITAMURA A., TANAKA M., SO C., RO S., et al. Differences in Tolerability of Antifibrotic Agents Between Connective Tissue Disease-Associated and Non-connective Tissue Disease-Associated Interstitial Lung Disease. Cureus. 2025;17(2):e78750.
- GILES J.T., DANOFF S.K., SOKOLOVE J., WAGNER C.A., WINCHESTER R., PAPPAS D.A., et al. Association of fine specificity and repertoire expansion of anticitrullinated peptide antibodies with rheumatoid arthritis associated interstitial lung disease. Ann Rheum Dis. 2014;73(8):1487–94.
- GILES J.T., DARRAH E., DANOFF S., JOHNSON C., ANDRADE F., ROSEN A., BATHON J.M. Association of cross-reactive antibodies targeting peptidyl-arginine deiminase 3 and 4 with rheumatoid arthritis-associated interstitial lung disease. PLoS One. 2014;9(6):e98794.
- KODURI G., NORTON S., YOUNG A., COX N., DAVIES P., DEVLIN J., et al. Interstitial lung disease has a poor prognosis in rheumatoid arthritis: results from an inception cohort. Rheumatology (Oxford). 2010;49(8):1483–9.
- RESTREPO J.F., DEL RINCON I., BATTAFARANO D.F., HAAS R.W., DORIA M., ESCALANTE A. Clinical and laboratory factors associated with interstitial lung disease in rheumatoid arthritis. Clin Rheumatol. 2015;34(9):1529–36.
- SOLOMON J.J., CHUNG J.H., COSGROVE G.P., DEMORUELLE M.K., FERNANDEZ-PEREZ E.R., FISCHER A., et al. Predictors of mortality in rheumatoid arthritis-associated interstitial lung disease. Eur Respir J. 2016;47(2):588–96.
- HYLDGAARD C., HILBERG O., MULLER A., BENDSTRUP E. A cohort study of interstitial lung diseases in central Denmark. Respir Med. 2014;108(5):793–9.
- HYLDGAARD C., HILBERG O., PEDERSEN A.B., ULRICHSEN S.P., LOKKE A., BENDSTRUP E., ELLINGSEN T. A population-based cohort study of rheumatoid arthritis-associated interstitial lung disease: comorbidity and mortality. Ann Rheum Dis. 2017;76(10):1700–6.
- SAKETKOO L.A., ESPINOZA L.R. Rheumatoid arthritis interstitial lung disease: mycophenolate mofetil as an antifibrotic and disease-modifying antirheumatic drug. Arch Intern Med. 2008;168(15):1718–9.
- SAKETKOO L.A., MATTESON E.L., BROWN K.K., SEIBOLD J.R., STRAND V., CONNECTIVE TISSUE DISEASE-RELATED INTERSTITIAL LUNG DISEASE SPECIAL INTEREST G. Developing disease activity and response criteria in connective tissue disease-related interstitial lung disease. J Rheumatol. 2011;38(7):1514–8.
- AKIYAMA M., KANEKO Y. Pathogenesis, clinical features, and treatment strategy for rheumatoid arthritis-associated interstitial lung disease. Autoimmun Rev. 2022;21(5):103056.
- ASSAYAG D., ELICKER B.M., URBANIA T.H., COLBY T.V., KANG B.H., RYU J.H., et al. Rheumatoid arthritis-associated interstitial lung disease: radiologic identification of usual interstitial pneumonia pattern. Radiology. 2014;270(2):583–8.
- SOLOMON J.J., DANOFF S.K., WOODHEAD F.A., HURWITZ S., MAURER R., GLASPOLE I., et al. Safety, tolerability, and efficacy of pirfenidone in patients with rheumatoid arthritis-associated interstitial lung disease: a randomised, double-blind, placebo-controlled, phase 2 study. Lancet Respir Med. 2023;11(1):87–96.
- MORI S., CHO I., KOGA Y., SUGIMOTO M. Comparison of pulmonary abnormalities on high-resolution computed tomography in patients with early versus longstanding rheumatoid arthritis. J Rheumatol. 2008;35(8):1513–21.
- ZAMORA-LEGOFF J.A., KRAUSE M.L., CROWSON C.S., RYU J.H., MATTESON E.L. Progressive Decline of Lung Function in Rheumatoid Arthritis-Associated Interstitial Lung Disease. Arthritis Rheumatol. 2017;69(3):542–9.
- ALETAHA D., NEOGI T., SILMAN A.J., FUNOVITS J., FELSON D.T., BINGHAM C.O., 3RD, et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis. 2010;69(9):1580–8.
- GRAHAM B.L., BRUSASCO V., BURGOS F., COOPER B.G., JENSEN R., KENDRICK A., et al. 2017 ERS/ATS standards for single-breath carbon monoxide uptake in the lung. Eur Respir J. 2017;49(1)
- GRAHAM B.L., STEENBRUGGEN I., MILLER M.R., BARJAKTAREVIC I.Z., COOPER B.G., HALL G.L., et al. Standardization of Spirometry 2019 Update. An Official American Thoracic Society and European Respiratory Society Technical Statement. Am J Respir Crit Care Med. 2019;200(8):e70–e88.
- STANOJEVIC S., KAMINSKY D.A., MILLER M.R., THOMPSON B., ALIVERTI A., BARJAKTAREVIC I., et al. ERS/ATS technical standard on interpretive strategies for routine lung function tests. Eur Respir J. 2022;60(1)
- TRAVIS W.D., COSTABEL U., HANSELL D.M., KING T.E., JR., LYNCH D.A., NICHOLSON A.G., et al. An official American Thoracic Society/European Respiratory Society statement: Update of the international multidisciplinary classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med. 2013;188(6):733–48.
- MYASOEDOVA E., MATTESON E.L. Updates on interstitial lung disease and other selected extra-articular manifestations of rheumatoid arthritis. Curr Opin Rheumatol. 2024;36(3):203–8.
- CROSS M., SMITH E., HOY D., CARMONA L., WOLFE F., VOS T., et al. The global burden of rheumatoid arthritis: estimates from the global burden of disease 2010 study. Ann Rheum Dis. 2014;73(7):1316–22.
- NURMI H.M., KETTUNEN H.P., SUORANTA S.K., PUROKIVI M.K., KARKKAINEN M.S., SELANDER T.A., KAARTEENAHO R.L. Several high-resolution computed tomography findings associate with survival and clinical features in rheumatoid arthritis-associated interstitial lung disease. Respir Med. 2018;134:24–30.
- NURMI H.M., PUROKIVI M.K., KARKKAINEN M.S., KETTUNEN H.P., SELANDER T.A., KAARTEENAHO R.L. Variable course of disease of rheumatoid arthritis-associated usual interstitial pneumonia compared to other subtypes. BMC Pulm Med. 2016;16(1):107.
- JUGE P.A., GRANGER B., DEBRAY M.P., EBSTEIN E., LOUIS-SIDNEY F., KEDRA J., et al. A Risk Score to Detect Subclinical Rheumatoid Arthritis-Associated Interstitial Lung Disease. Arthritis Rheumatol. 2022;74(11):1755–65.
- KODURI G.M., PODLASEK A., PATTAPOLA S., ZHANG J., LAILA D., NANDAGUDI A., et al. Four-factor risk score for the prediction of interstitial lung disease in rheumatoid arthritis. Rheumatol Int. 2023;43(8):1515–23.
- YUNT Z.X., CHUNG J.H., HOBBS S., FERNANDEZ-PEREZ E.R., OLSON A.L., HUIE T.J., et al. High resolution computed tomography pattern of usual interstitial pneumonia in rheumatoid arthritis-associated interstitial lung disease: Relationship to survival. Respir Med. 2017;126:100–4.
- YUNT Z.X., SOLOMON J.J. Lung disease in rheumatoid arthritis. Rheum Dis Clin North Am. 2015;41(2):225–36.
- HACKNER K., HÜTTER L., FLICK H., GROHS M., KASTRATI K., KIENER H., et al. Screening for rheumatoid arthritis-associated interstitial lung disease—a Delphi-based consensus statement. Zeitschrift für Rheumatologie. 2024;83(2):160–8.
- DOYLE T.J., LEE J.S., DELLARIPA P.F., LEDERER J.A., MATTESON E.L., FISCHER A., et al. A roadmap to promote clinical and translational research in rheumatoid arthritis-associated interstitial lung disease. Chest. 2014;145(3):454–63.
- TANAKA N., KIM J.S., NEWELL J.D., BROWN K.K., COOL C.D., MEEHAN R., et al. Rheumatoid arthritis-related lung diseases: CT findings. Radiology. 2004;232(1):81–91.
- KIM E.J., COLLARD H.R., KING T.E., JR. Rheumatoid arthritis-associated interstitial lung disease: the relevance of histopathologic and radiographic pattern. Chest. 2009;136(5):1397–405.
- MORI S., KOGA Y., SUGIMOTO M. Small airway obstruction in patients with rheumatoid arthritis. Mod Rheumatol. 2011;21(2):164–73.
- GOCHUICO B.R. Potential pathogenesis and clinical aspects of pulmonary fibrosis associated with rheumatoid arthritis. Am J Med Sci. 2001;321(1):83–8.
- GOCHUICO B.R., AVILA N.A., CHOW C.K., NOVERO L.J., WU H.P., REN P., et al. Progressive preclinical interstitial lung disease in rheumatoid arthritis. Arch Intern Med. 2008;168(2):159–66.
- JUGE P.A., LEE J.S., LAU J., KAWANO-DOURADO L., ROJAS SERRANO J., SEBASTIANI M., et al. Methotrexate and rheumatoid arthritis associated interstitial lung disease. Eur Respir J. 2021;57(2)
- KIELY P., BUSBY A.D., NIKIPHOROU E., SULLIVAN K., WALSH D.A., CREAMER P., et al. Is incident rheumatoid arthritis interstitial lung disease associated with methotrexate treatment? Results from a multivariate analysis in the ERAS and ERAN inception cohorts. BMJ Open. 2019;9(5):e028466.
- REMY-JARDIN M., REMY J., CORTET B., MAURI F., DELCAMBRE B. Lung changes in rheumatoid arthritis: CT findings. Radiology. 1994;193(2):375–82.
- GUIOT J., HENKET M., ERNST M., SEIDEL L., WINANDY M., DENIS A., et al. Airflow obstruction as a marker of adverse prognosis in rheumatoid arthritis. Front Med (Lausanne). 2023;10:1063012.
- AL-BALDAWI S., ZÚÑIGA SALAZAR G., ZÚÑIGA D., BALASUBRAMANIAN S., MEHMOOD K.T. Interstitial Lung Disease in Rheumatoid Arthritis: A Review. Cureus. 2024;16(2):e53632.
- KADURA S., RAGHU G. Rheumatoid arthritis-interstitial lung disease: manifestations and current concepts in pathogenesis and management. European Respiratory Review. 2021;30(160):210011.
- LARIA A., LURATI A.M., ZIZZO G., ZACCARA E., MAZZOCCHI D., RE K.A., et al. Interstitial Lung Disease in Rheumatoid Arthritis: A Practical Review. Frontiers in Medicine. 2022;Volume 9 - 2022
- NARVÁEZ J., ABURTO M., SEOANE-MATO D., BONILLA G., ACOSTA O., CANDELAS G., et al. Screening criteria for interstitial lung disease associated to rheumatoid arthritis: Expert proposal based on Delphi methodology. Reumatol Clin (Engl Ed). 2023;19(2):74–81.
- WHEELER A.M., BAKER J.F., RILEY T., YANG Y., ROUL P., WYSHAM K.D., et al. Development and internal validation of a clinical and genetic risk score for rheumatoid arthritis-associated interstitial lung disease. Rheumatology. 2024;64(1):268–75.
- PAULIN F., DOYLE T.J., MERCADO J.F., FASSOLA L., FERNÁNDEZ M., CARO F., et al. Development of a risk indicator score for the identification of interstitial lung disease in patients with rheumatoid arthritis. Reumatología Clínica (English Edition). 2021;17(4):207–11.
- XUE J., HU W., WU S., WANG J., CHI S., LIU X. Development of a Risk Nomogram Model for Identifying Interstitial Lung Disease in Patients With Rheumatoid Arthritis. Frontiers in Immunology. 2022;Volume 13 - 2022
- PRASANNA H., INDERJEETH C.A., NOSSENT J.C., ALMUTAIRI K.B. The global prevalence of interstitial lung disease in patients with rheumatoid arthritis: a systematic review and meta-analysis. Rheumatol Int. 2025;45(2):34.
- JACOB J., SONG J.W., YOON H.Y., CROSS G., BARNETT J., WOO W.L., et al. Prevalence and Effects of Emphysema in Never-Smokers with Rheumatoid Arthritis Interstitial Lung Disease. EBioMedicine. 2018;28:303–10.
- JOHNSON S.R., BERNSTEIN E.J., BOLSTER M.B., CHUNG J.H., DANOFF S.K., GEORGE M.D., et al. 2023 American College of Rheumatology (ACR)/American College of Chest Physicians (CHEST) Guideline for the Treatment of Interstitial Lung Disease in People with Systemic Autoimmune Rheumatic Diseases. Arthritis Rheumatol. 2024;76(8):1182–200.
Language: English
Submitted on: Feb 24, 2026
Published on: Apr 13, 2026
Published by: N.G. Lupu Internal Medicine Foundation
In partnership with: Paradigm Publishing Services
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© 2026 Oana-Georgiana Dinache, Claudiu C. Popescu, Corina D. Mogoșan, Cătălin Codreanu, Luminita Enache, published by N.G. Lupu Internal Medicine Foundation
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