Current diagnostic pathways for rheumatoid arthritis-associated interstitial lung disease result in substantial underdiagnosis and excess mortality: A multicenter Norwegian quality assurance audit

Ikdahl, E; Døskeland, B; Bertelsen, LT; Bakland, G; Pedersen, TT; Hu, Y; Diep, PP; Sundbakk, LM; Provan, SA; Hoffmann-Vold, AM

doi:10.1016/j.jbspin.2026.106130

Rheumatoid arthritis

Current diagnostic pathways for rheumatoid arthritis-associated interstitial lung disease result in substantial underdiagnosis and excess mortality: A multicenter Norwegian quality assurance audit

Joint Bone SpinePublished 1 Sep 2026Multicentre quality assurance audit

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Authors' conclusion

When comparing to prevalence expectations, current routine care may leave a substantial proportion of cases undetected, primarily capturing a high-risk phenotype with excess mortality.

Study context

Population: RA patients at six Norwegian centers covering 43% of the Norwegian population
Participants: 17,305 RA patients

Comparison: RA-ILD vs 3:1 frequency-matched RA controls (mortality); detected prevalence vs 10% expected target
RA-ILDn = 188
Outcome: Prevalence of currently detected RA-ILD, benchmarked against a 10% expected target

Methodological details10-year, six centers, ICD-10 case identification confirmed by manual chart review, 3:1 frequency-matched RA controls, Cox proportional hazards regression

10-year
Six centers
ICD-10 case identification confirmed by manual chart review
3:1 frequency-matched RA controls
Cox proportional hazards regression

Main finding

As reported in the abstract

Verified ILD prevalence among RA patients

RA-ILD

1.1%

188

Diagnostic gap vs expected 10% prevalence: 89%

Further findings

Outcome	RA-ILD	RA controls	← Lower risk with RA-ILD ←→ Higher risk with RA-ILD →	HR (95% CI)	P value
Mortality	4.1/100 person-years	2.3/100 person-years	0.512	1.77 (1.31–2.39)	P < 0.001
			0.512Hazard ratio (log scale)

Characteristics of RA-ILD cases

Mean age at ILD detection (years): 67.5
≥2 established risk factors: 93.6%
Seropositive: 93.6%
Smoking history: 76.1%
RA onset age≥60 and persistently increased inflammatory markers: over half

Original publication

Current diagnostic pathways for rheumatoid arthritis-associated interstitial lung disease result in substantial underdiagnosis and excess mortality: A multicenter Norwegian quality assurance audit. Joint Bone Spine. Published 1 September 2026. doi:10.1016/j.jbspin.2026.106130

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