Risk factors for interstitial lung disease in early rheumatoid arthritis and external validation of screening strategies: a cross-sectional analysis of the prospective SAIL-RA cohort in the USA
An erratum to this article was published (Lancet Rheumatol, Feb 2026 ↗)
Authors' conclusion
In this population with early rheumatoid arthritis, 11% had rheumatoid arthritis-associated ILD. Moderate or high disease activity and age of 60 years or older were strongly associated with rheumatoid arthritis-associated ILD in early rheumatoid arthritis. Several proposed screening strategies using factors routinely available at the point of care showed promise for detecting rheumatoid arthritis-associated ILD in early rheumatoid arthritis.
Study context
- Population
- Patients with early RA (within 2 years of diagnosis), five academic health-care centres in the USA; recruited May 1, 2017–Feb 22, 2024completed high-resolution CT (HRCT)
- Participants
- 172 patients
- Outcome
- Presence of RA-associated ILD (independent review of HRCTs by thoracic radiologists)
Methodological detailsmulticentre (five academic health-care centres), multivariable logistic regression, external validation of screening strategies
- Multicentre (five academic health-care centres)
- Multivariable logistic regression
- External validation of screening strategies
Main finding
As reported in the abstract
RA-associated interstitial lung disease (ILD) on HRCT
19
11%
Observational data: associations, not effects.
Further findings
| Outcome | aOR (95% CI) | |
|---|---|---|
| Risk factors for RA-associated ILDModerate or high disease activity (DAS28-ESR ≥3.2)vs Remission or low disease activity | 7.00 (1.95–25.13) | |
| Risk factors for RA-associated ILDAge ≥60 yearsvs Age <60 years | 3.87 (1.33–11.27) | |
| 0.050.21520Adjusted odds ratio (log scale) |
Performance of screening strategies for RA-associated ILD
- Lowest sensitivity: Paulin criteria (four-point cutoff), 95% CI 0.00-0.15
- 0.05
- Highest sensitivity: ANCHOR-RA and ACR-CHEST criteria (one-factor cutoff), 95% CI 0.97-1.00
- 1.00
- Lowest specificity: ACR-CHEST criteria (one-factor cutoff), 95% CI 0.06-0.16
- 0.11
- Highest specificity: Paulin criteria (four-point cutoff), 95% CI 0.95-1.0
- 0.97
- Number needed to screen to detect one case, lowest: ESPOIR criteria (two-factor cutoff)
- 3.6
- Number needed to screen to detect one case, highest
- 7.7
Original publication
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