Validation of screening criteria for interstitial lung disease in rheumatoid arthritis in routine clinical practice: the VAR-EPIDSER study
Authors' conclusion
In Spanish patients with RA, undiagnosed ILD is frequent and mostly subclinical. The AR-EPIDSER criteria are useful as an initial screening tool due to high sensitivity and excellent NPV; however, low specificity suggests that positive cases should be confirmed by HRCT.
Study context
- Population
- Adults with rheumatoid arthritis (RA) (American College of Rheumatology (ACR) 1987 or ACR/EULAR 2010 criteria) without previous interstitial lung disease (ILD) diagnosis, 15 Spanish hospitals424 with evaluable high-resolution CT (HRCT)
- Participants
- 477 adults
- Comparison
- AR-EPIDSER screening criteria vs HRCT of the chest
- Outcome
- Validity (sensitivity, specificity, PPV, NPV) of the AR-EPIDSER screening criteria for detecting RA-ILD vs HRCT
Methodological detailsmulticentre, cross-sectional, observational, centralised HRCT reading
- Multicentre
- Cross-sectional
- Observational
- Centralised HRCT reading
Performance
As reported in the abstract
Diagnostic performance of AR-EPIDSER criteria for ILD
| Test or model | Sensitivity | Specificity | PPV | NPV | Screening positive |
|---|---|---|---|---|---|
| AR-EPIDSER criteria | 0.93 (95% CI 0.82 to 0.98) | 0.36 (0.31 to 0.41) | 0.18 (0.13 to 0.23) | 0.97 (0.93 to 0.99) | 68.2% (289/424) |
AR-EPIDSER criteria
Sensitivity0.93 (95% CI 0.82 to 0.98)
Specificity0.36 (0.31 to 0.41)
PPV0.18 (0.13 to 0.23)
NPV0.97 (0.93 to 0.99)
Screening positive68.2% (289/424)
Further findings
Prevalence of ILD on HRCT
- ILD on HRCT (55/424)
- 13.0%
- 95% CI 9.9% to 16.6%
Prevalence of subclinical ILD (no cough, dyspnoea or 'Velcro-like' crackles)
- Subclinical ILD (35/424)
- 8.3%
- Share of ILD cases that were subclinical
- 63.6%
- 95% CI 5.7% to 11.1%
Positive AR-EPIDSER screening
- Screening positive (289/424)
- 68.2%
Original publication
Validation of screening criteria for interstitial lung disease in rheumatoid arthritis in routine clinical practice: the VAR-EPIDSER study. RMD Open. Published 18 May 2026. doi:10.
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