Pos0608 Evaluation of a Screening Tool to Identify Risk for Subclinical Interstitial Lung Disease in Patients With Rheumatoid Arthritis Treated With Targeted Therapies

Background: Interstitial lung disease (ILD) is the second leading cause of mortality in patients with rheumatoid arthritis (RA) (1). However, is frequently underrecognized as presents a highly variable clinical course, ranging from subclinical ILD to rapid progression to pulmonary fibrosis. Although, RA-ILD may have a substantial impact on prognosis, there are insufficient data to inform evidence-based recommendations on screening. In a combined effort by expert rheumatologists and pulmonologists, a screening tool based on risk factors for RA-ILD have been recently proposed (2). However, this risk score has not been validated in clinical practice. Objectives: To evaluate risk factors and treatment in patients with RA-ILD in comparison with patients without ILD in a cohort of RA patients with targeted therapies and to examine different cut-off points for the screening tool to identify patients at risk to develop ILD. Methods: Cohort study from a single academic center of RA patients undergoing targeted therapies. Risk factors associated with the development of ILD and current treatment were compared between RA-ILD and RA-noILD patients. The proposed risk score based on sex, age, smoking status, RA duration, rheumatoid factor and anti–cyclic citrullinated protein antibodies was calculated and different cut-off values were explored to identify patients at risk for ILD on the basis of the best trade-off values between sensitivity and specificity from a ROC curve analysis. Results: A total of 688 patients with RA treated with targeted therapies were included in our cohort, 31 (4.5%) with RA-ILD. RA-ILD patients were elder at RA onset (54.9 vs 45.2, p<0.05) and more frequently smokers (48.4% vs 14%, p<0.05) (Table 1). Different patterns in treatment were observed between groups, RA-ILD patients were receiving more frequently abatacept (32%) followed by tocilizumab (22%) and JAKi (19%). The area under the receiver operating characterize curve (AUC) with 95% confidence interval was 0.75 95%CI (0.67-0.84) (Figure 1). Three different cut-off points for the risk score were evaluated: 5 (Sens 86.7%, Spec 48.7% LR+1.7) corresponding to 228 patients (36.5%) in our cohort, 6 (Sens 76.7%, Spec 63.5% LH+ 2.1) 59 patients (9.5%), and 7 (Sens 36.7%, Spec 90.5% LH+ 3.9) 14 (2.2%) (Figure 1). Conclusion: Prevalence of ILD in our cohort of patients with RA and targeted therapies was 4.5%. The risk score identified 36% patients at low risk, 9.5% at moderate risk, and 2.2% at high risk of subclinical RA-ILD. The use of screening tools could favor the early detection of subclinical ILD and assist rheumatologists in early intervention to improve the prognosis of RA-ILD. REFERENCES: [1] Kronzer VL, Huang W, et al. J Rheumatol. 2021 May;48(5):656–63. [2] Narváez J, Aburto M, et al. Reumatol Clínica. 2023 Feb;19(2):74–81. Acknowledgements: This work was supported by the following grants: PI20/00847, PI23/01226 and RD21/0002/0034 from Instituto de Salud Carlos III and co-financed by the European Regional Development Fund. Disclosure of Interests: None declared.