Screening criteria for interstitial lung disease associated to rheumatoid arthritis: Expert proposal based on Delphi methodology

Objective Interstitial lung disease (ILD) is one of the commonest systemic complications in patients with rheumatoid arthritis (RA) and carries a significant morbidity and mortality burden. We aimed to identify key variables to risk-stratify RA patients in order to identify those at increased risk of developing ILD. We propose a probability score based on the identification of these variables. Methods A retrospective, multicentre study using clinical data collected between 2010 and 2020, across 20 centres. Results A total of 430 RA (210 with ILD confirmed on high-resolution computed tomography (HRCT)) patients were evaluated. We explored several independent variables for the risk of developing ILD in RA and found that the key significant variables were smoking (past or present), older age and positive rheumatoid factor/anti-cyclic citrullinated peptide. Multivariate logistic regression models were used to form a scoring system for categorising patients into high and low risk on a scale of 0–9 points and a cut-off score of 5, based on the area under the receiver operating characteristic curve of 0.76 (CI 95% 0.71–0.82). This yielded a sensitivity of 86% and a specificity of 58%. High-risk patients should be considered for investigation with HRCT and monitored closely. Conclusion We have proposed a new model for identifying RA patients at risk of developing ILD. This approach identified four simple clinical variables: age, anti-cyclic citrullinated peptide antibodies, Rheumatoid factor and smoking, which allowed development of a predictive scoring system for the presence of ILD in patients with RA.

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“…Our model supports the Spanish algorithm [42] but takes a step further to risk-stratify patients at disease diagnosis.…”

Section: Discussionmentioning

confidence: 86%

Four-factor risk score for the prediction of interstitial lung disease in rheumatoid arthritis

et al. 2023

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“…Experts have agreed that the low incidence of clinically relevant RA-ILD in their practice does not justify its inclusion in the group of diseases with a high prevalence of CTD-ILD, although it should be noted that the symptoms of RA are very similar to idiopathic pulmonary fibrosis and predict worse survival [ 7 ]. The unmet need for a screening strategy for ILD in RA was recently addressed by a Spanish multidisciplinary team [ 37 ]. It is important to point out that we should be careful to exclude diffuse alveolar hemorrhage in patients with SLE who develop acute respiratory symptoms and respiratory failure.…”

Section: Discussionmentioning

confidence: 99%

Delphi-Based Consensus on Interstitial Lung Disease Screening in Patients with Connective Tissue Diseases (Croatian National-Based Study)

et al. 2022

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The aim of this study was to develop a Croatian Delphi-based expert consensus for screening interstitial lung disease (ILD) associated with connective tissue disease (CTD). A systematic literature review was conducted on risk factors for the development of ILD, prevalence and incidence of ILD, diagnostic and screening methods for ILD, and prognosis of ILD in idiopathic inflammatory myopathy (IIM), mixed connective tissue disease (MCTD), primary Sjögren’s syndrome (pSS), rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and systemic sclerosis (SSc) were performed. Based on the evidence found, experts developed questionnaires for screening and monitoring ILD in each CTD, which were provided via an online survey. Following the electronic survey, two screening algorithms were developed based on the consensus opinions. The detection strategy for ILD included high-resolution computed tomography (HRCT) in addition to pulmonary function testing for IIM, MCTD, and SSc. and pulmonary function testing for newly diagnosed pSS, RA and SLE. However, in patients with identified risk factors for ILD HRCT, these tests should also be performed. A screening strategy for early identification of patients with various CTD-ILD was first developed by a multidisciplinary team of rheumatologists, pulmonologists, and radiologists to identify early CTD patients at risk of ILD, a severe extra-articular manifestation of CTD.

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“…[45][46][47] Risk factors for ILD in RA include male sex, active RA disease activity, and positive serology (anticyclic citrullinated protein and rheumatoid factor). [48][49][50] The most common pattern of ILD is UIP. 2 Prognostic markers include low and worsening FVC and diffusing capacity of the lungs for carbon monoxide (DLCO), increased fibrotic extent on histopathology and HRCT, and older age.…”

Section: Rheumatoid Arthritismentioning

confidence: 99%

Novel Therapeutic Approaches in Connective Tissue Disease-Associated Interstitial Lung Disease

Mulcaire-Jones,

Pugashetti,

Oldham

et al. 2024

Semin Respir Crit Care Med

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Connective tissue diseases (CTD) comprise a group of autoimmune diseases that can affect multiple organs in the body including the lungs. The most common form of pulmonary involvement is interstitial lung disease (ILD). CTD-associated ILD (CTD-ILD) can take one of several courses including nonprogressive, chronically progressive, or rapidly progressive. Chronically and rapidly progressive patterns are associated with increased mortality. Limited randomized controlled trial data are available for treatment of CTD-ILD, with most data coming from systemic sclerosis-related ILD. The current first-line treatment for all CTD-ILD is immunosuppression with consideration of antifibrotics, stem cell transplant, and lung transplant in progressive disease. In this article, we review data for ILD treatment options in systemic sclerosis, rheumatoid arthritis, myositis, and primary Sjögren's syndrome-related ILDs.

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Screening criteria for interstitial lung disease associated to rheumatoid arthritis: Expert proposal based on Delphi methodology

Cited by 10 publications

References 46 publications

Four-factor risk score for the prediction of interstitial lung disease in rheumatoid arthritis

Four-factor risk score for the prediction of interstitial lung disease in rheumatoid arthritis

Delphi-Based Consensus on Interstitial Lung Disease Screening in Patients with Connective Tissue Diseases (Croatian National-Based Study)

Novel Therapeutic Approaches in Connective Tissue Disease-Associated Interstitial Lung Disease

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