Are we screening effectively? A systematic review and meta-analysis of proposed risk factors for rheumatoid arthritis-associated interstitial lung disease screening.

To systematically review and meta-analyse the risk factors proposed by the American College of Rheumatology and American College of Chest Physicians as screening tools for rheumatoid arthritis-associated interstitial lung disease (RA-ILD), focusing exclusively on studies using high-resolution computed tomography (HRCT) in prospectively collected data from unselected RA patients. A comprehensive search was conducted to identify studies evaluating RA-ILD risk factors. Selection criteria included studies using HRCT in prospective, unselected RA cohorts. Data synthesis was performed to compute the prevalence of RA-ILD and evaluate the performance of dichotomous and continuous risk factors. In the analysis of nine studies involving 1380 RA patients, RA-ILD was identified in 18.9% via HRCT, with prevalence rates ranging from 6.7% to 42.7%. No studies were found that examined the risk factors collectively. Male sex and history of smoking were, respectively, 12.6% and 12.2% higher in RA-ILD patients compared to those without ILD. Average age at RA disease onset was 7.0 years higher in RA-ILD patients than in the non-ILD group. Disease Activity Scores in 28 joints (DAS28) were similar between the two groups. However, limited data were available for high-titre seropositivity and body mass index. The proposed risk factors for RA-ILD screening lack robust evidence, and existing data indicate insufficient individual predictive power. Physicians are advised to continue screening for RA-ILD using comprehensive clinical judgement rather than relying solely on these risk factors. Further research is necessary to develop robust screening tools to improve early detection of RA-ILD.