below then 
SCREENING AT-RISK PATIENTS
A suggested algorithm to identify RA-ILD in patients with RA
A clinical management algorithm for RA was defined1-6,*
Patient history and
physical exam
Do patient’s clinical symptoms include unexplained dyspnea or cough and/or inspiratory crackles on auscultation?
*There is currently no consensus in recommendations regarding screening, diagnosis, and management of RA-ILD. The following information is based on the best currently available evidence.
References:
1. Cassone G et al. J Clin Med. 2020;9(4):1082.
2. Esposito AJ et al. Clin Chest Med. 2019;40(3):545-560.
3. Wallace B et al. Curr Opin Rheumatol. 2016;28(3):236-245.
4. Iqbal K and Kelly C. Ther Adv Musculoskelet Dis. 2015;7(6):247-267.
5. Olson A et al. Adv Ther. 2020. doi:10.1007/s12325-020-01578-6.
6. Cottin V et al. Eur Respir Rev. 2019;28(151). doi:10.1183/16000617.0100-2018.
Conduct HRCT
and full PFTs
*There is currently no consensus in recommendations regarding screening, diagnosis, and management of RA-ILD. The following information is based on the best currently available evidence.
References:
1. Cassone G et al. J Clin Med. 2020;9(4):1082.
2. Esposito AJ et al. Clin Chest Med. 2019;40(3):545-560.
3. Wallace B et al. Curr Opin Rheumatol. 2016;28(3):236-245.
4. Iqbal K and Kelly C. Ther Adv Musculoskelet Dis. 2015;7(6):247-267.
5. Olson A et al. Adv Ther. 2020. doi:10.1007/s12325-020-01578-6.
6. Cottin V et al. Eur Respir Rev. 2019;28(151). doi:10.1183/16000617.0100-2018.
Does your patient have any positive risk factors for RA-ILD?†
- ≥65 years old
- Male gender
- History of smoking
- Anti-CCP+ and/or high-titer RF
- Clinically severe RA
*There is currently no consensus in recommendations regarding screening, diagnosis, and management of RA-ILD. The following information is based on the best currently available evidence.
†Patients over the age of 55 who are current smokers or quit within the past 15 years and have a history of at least 30-pack years are eligible for a lung cancer screening that includes a low-dose chest CT scan. If abnormal, conduct HRCT and full PFTs.2
References:
1. Cassone G et al. J Clin Med. 2020;9(4):1082.
2. Esposito AJ et al. Clin Chest Med. 2019;40(3):545-560.
3. Wallace B et al. Curr Opin Rheumatol. 2016;28(3):236-245.
4. Iqbal K and Kelly C. Ther Adv Musculoskelet Dis. 2015;7(6):247-267.
5. Olson A et al. Adv Ther. 2020. doi:10.1007/s12325-020-01578-6.
6. Cottin V et al. Eur Respir Rev. 2019;28(151). doi:10.1183/16000617.0100-2018.
Spirometry
+/- DLCO
*There is currently no consensus in recommendations regarding screening, diagnosis, and management of RA-ILD. The following information is based on the best currently available evidence.
References:
1. Cassone G et al. J Clin Med. 2020;9(4):1082.
2. Esposito AJ et al. Clin Chest Med. 2019;40(3):545-560.
3. Wallace B et al. Curr Opin Rheumatol. 2016;28(3):236-245.
4. Iqbal K and Kelly C. Ther Adv Musculoskelet Dis. 2015;7(6):247-267.
5. Olson A et al. Adv Ther. 2020. doi:10.1007/s12325-020-01578-6.
6. Cottin V et al. Eur Respir Rev. 2019;28(151). doi:10.1183/16000617.0100-2018.
Continue monitoring
for signs of ILD
Restart*There is currently no consensus in recommendations regarding screening, diagnosis, and management of RA-ILD. The following information is based on the best currently available evidence.
References:
1. Cassone G et al. J Clin Med. 2020;9(4):1082.
2. Esposito AJ et al. Clin Chest Med. 2019;40(3):545-560.
3. Wallace B et al. Curr Opin Rheumatol. 2016;28(3):236-245.
4. Iqbal K and Kelly C. Ther Adv Musculoskelet Dis. 2015;7(6):247-267.
5. Olson A et al. Adv Ther. 2020. doi:10.1007/s12325-020-01578-6.
6. Cottin V et al. Eur Respir Rev. 2019;28(151). doi:10.1183/16000617.0100-2018.
Continue monitoring via annual spirometry
Restart*There is currently no consensus in recommendations regarding screening, diagnosis, and management of RA-ILD. The following information is based on the best currently available evidence.
References:
1. Cassone G et al. J Clin Med. 2020;9(4):1082.
2. Esposito AJ et al. Clin Chest Med. 2019;40(3):545-560.
3. Wallace B et al. Curr Opin Rheumatol. 2016;28(3):236-245.
4. Iqbal K and Kelly C. Ther Adv Musculoskelet Dis. 2015;7(6):247-267.
5. Olson A et al. Adv Ther. 2020. doi:10.1007/s12325-020-01578-6.
6. Cottin V et al. Eur Respir Rev. 2019;28(151). doi:10.1183/16000617.0100-2018.
Conduct HRCT
and full PFTs
*There is currently no consensus in recommendations regarding screening, diagnosis, and management of RA-ILD. The following information is based on the best currently available evidence.
References:
1. Cassone G et al. J Clin Med. 2020;9(4):1082.
2. Esposito AJ et al. Clin Chest Med. 2019;40(3):545-560.
3. Wallace B et al. Curr Opin Rheumatol. 2016;28(3):236-245.
4. Iqbal K and Kelly C. Ther Adv Musculoskelet Dis. 2015;7(6):247-267.
5. Olson A et al. Adv Ther. 2020. doi:10.1007/s12325-020-01578-6.
6. Cottin V et al. Eur Respir Rev. 2019;28(151). doi:10.1183/16000617.0100-2018.
Confirm RA-ILD diagnosis
Abnormal HRCT combined with multidisciplinary discussion provides high confidence in diagnosis of RA-ILD. In addition to HRCT, diagnosis is primarily based on clinical examination and PFTs†
*There is currently no consensus in recommendations regarding screening, diagnosis, and management of RA-ILD. The following information is based on the best currently available evidence.
†UIP is the most common HRCT pattern seen in patients with RA-ILD.2,7
References:
1. Cassone G et al. J Clin Med. 2020;9(4):1082.
2. Esposito AJ et al. Clin Chest Med. 2019;40(3):545-560.
3. Wallace B et al. Curr Opin Rheumatol. 2016;28(3):236-245.
4. Iqbal K and Kelly C. Ther Adv Musculoskelet Dis. 2015;7(6):247-267.
5. Olson A et al. Adv Ther. 2020. doi:10.1007/s12325-020-01578-6.
6. Cottin V et al. Eur Respir Rev. 2019;28(151). doi:10.1183/16000617.0100-2018.
7. Geertz S et al. Sarcoidosis Vasc Diffuse Lung Disease. 2017;34(4);326-335.
Continue to monitor your patient for progression
Monitor for increasing extent of fibrosis on HRCT, worsening respiratory symptoms, and lung function decline
*There is currently no consensus in recommendations regarding screening, diagnosis, and management of RA-ILD. The following information is based on the best currently available evidence.
References:
1. Cassone G et al. J Clin Med. 2020;9(4):1082.
2. Esposito AJ et al. Clin Chest Med. 2019;40(3):545-560.
3. Wallace B et al. Curr Opin Rheumatol. 2016;28(3):236-245.
4. Iqbal K and Kelly C. Ther Adv Musculoskelet Dis. 2015;7(6):247-267.
5. Olson A et al. Adv Ther. 2020. doi:10.1007/s12325-020-01578-6.
6. Cottin V et al. Eur Respir Rev. 2019;28(151). doi:10.1183/16000617.0100-2018.
Treatment
Treatment for RA-ILD should be
escalated when ILD progresses
Adapted from: Esposito AJ et al. Clin
Chest Med. 2019;40(3):545-560.
*There is currently no consensus in recommendations regarding screening, diagnosis, and management of RA-ILD. The following information is based on the best currently available evidence.
References:
1. Cassone G et al. J Clin Med. 2020;9(4):1082.
2. Esposito AJ et al. Clin Chest Med. 2019;40(3):545-560.
3. Wallace B et al. Curr Opin Rheumatol. 2016;28(3):236-245.
4. Iqbal K and Kelly C. Ther Adv Musculoskelet Dis. 2015;7(6):247-267.
5. Olson A et al. Adv Ther. 2020. doi:10.1007/s12325-020-01578-6.
6. Cottin V et al. Eur Respir Rev. 2019;28(151). doi:10.1183/16000617.0100-2018.