But there’s nothing wrong with using more established screening tools, new research suggests.
The latest SAIL-RA findings have explored the risk factors and screening tools for interstitial lung disease in early rheumatoid arthritis.
There are multiple screening strategies available to assess the risk of rheumatoid arthritis-associated interstitial lung disease, but it is not clear how well these tools perform in people with newly diagnosed RA.
Now, new data from the American Study of Inflammatory Arthritis and Interstitial Lung Disease in Early RA (SAIL-RA) initiative has put these various screening tools under the microscope, and revealed they have high sensitivity for detecting RA-ILD in patients with early RA.
“The study findings recapitulate several known risk factors for RA-associated ILD and emphasise their importance in early RA,” the study authors wrote in The Lancet Rheumatology.
As part of the longitudinal, prospective study that took place across five sites in the United States, patients who had been diagnosed with RA in the last two years were recruited and underwent a complete screening assessment that involved surveying patients about their medical history, undergoing physical exams, having a high-resolution chest CT, completing pulmonary function testing and blood drawn to determine their erythrocyte sedimentation rate (ESR).
The researchers used this swathe of data to explore the prevalence of RA-associated ILD in patients with early RA and to test the performance of six different strategies used to screen for RA-associated ILD.
Specifically, they examined the eligibility criteria for the ANCHOR-RA screening study for RA-associated ILD, the risk factors listed in the 2023 ACR-CHEST ILD screening and monitoring guidelines, the risk factors outlined by the Evaluation et Suivi de Polyarthrites Indifférenciées Récentes (ESPOIR), the four-factor weighted risk score, the Sociedad Española de Reumatología and Sociedad Española de Neumología y Cirugía Torácica (SER-SEPAR) criteria and the Paulin criteria.
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The final sample included 172 patients, who were predominantly female (74%) and had a mean age of 55.3 years. Researchers identified RA-associated ILD in 19 patients (11%), with a further nine patients having bronchiectasis or emphysema without RA-ILD. The remaining 144 patients displayed no evidence of parenchymal lung disease on their high-resolution chest CT.
After adjusting for the effects of age at RA diagnosis and sex, individuals with moderate or high levels of RA disease activity (defined as a Disease Activity Score with 28 joints and ESR of 3.2 or greater) had a seven-fold increase in the odds of being diagnosed with RA-associated ILD compared to patients with remission or low disease activity (DAS28-ESR less than 3.2).
“These findings suggest that disease activity in early RA might play a pivotal role in the development of RA-associated ILD and other RA-related lung diseases, and serve as a highly informative risk factor for screening for RA-associated ILD,” the researchers noted.
The assessment of the six different screening strategies showed that the ANCHOR-RA, 2023 ACR–CHEST and ESPOIR–SAIL-RA strategies had high sensitivity but poor specificity when a cutoff of at least one factor was used. Increasing the cutoff to two risk factors reduced sensitivity but improved specificity. The remaining screening strategies had low sensitivity and high specificity for RA-ILD screening.
“These strategies showed high sensitivity and required four to eight patients to be screened to detect a case of RA-associated ILD,” the researchers concluded.
“The simplest model consisted of age at onset of RA of 60 years or older, male sex and active RA, suggesting these three factors, which are routinely available at the point of care, might be suitable to stratify risk for ILD in early RA.”
