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. 2025 Aug:73:152719.
doi: 10.1016/j.semarthrit.2025.152719. Epub 2025 Apr 12.

Rheumatoid arthritis-associated interstitial lung disease in countries across the world

Sascha L Heckert  1 , Tjardo D Maarseveen  1 , Emiel R Marges  2 , Arvind Chopra  3 , David Vega-Morales  4 , Riette du Toit  5 , Lai Ling Winchow  6 , Nimmisha Govind  6 , Carlos E Toro-Gutiérrez  7 , Rachel Knevel  8 , Annette Hm van der Helm-van Mil  1 , Tom Wj Huizinga  1 , Cornelia F Allaart  1 , Sytske Anne Bergstra  9
Affiliations
Free article

Rheumatoid arthritis-associated interstitial lung disease in countries across the world

Sascha L Heckert et al. Semin Arthritis Rheum. 2025 Aug.
Free article

Abstract

Objectives: We aimed to describe the incidence of RA-ILD in various countries worldwide, and to explore its association with RA disease activity.

Methods: In 5 countries, data on RA-ILD (clinical diagnosis based on chest X-ray or CT) were collected RA patients of two observational databases (METEOR, EAC). We investigated a possible association between disease activity over time and RA-ILD.

Results: 16,663 patients with RA with variable disease duration were evaluated. At the first visit recorded in the database, 1/1077 (0.09 %) patients from The Netherlands, 63/11,787 (0.53 %) from India, 8/629 (1.27 %) from South Africa, 6/424 (1.42 %) from Mexico and 17/2728 (0.62 %) from Colombia had an RA-ILD diagnosis. The incidence rate of RA-ILD in patients with newly diagnosed RA was 3.8 (95 % CI 1.6 to 9.1) per 1000 patient years in The Netherlands, 1.6 (95 % CI 1.0 to 2.5) in India and 6.6 (95 % CI 2.5-17.5) in South Africa. The OR for RA-ILD development, per point increase in DAS28 over time was 1.19 (95 % CI 0.34 to 4.22). Disease activity after the RA-ILD diagnosis or a matched timepoint was statistically significantly higher in patients with RA-ILD than in controls (β 0.56 (95 % CI 0.18 to 0.93). There were no clear differences in DMARD use between the two groups.

Conclusion: Despite slight differences in RA-ILD prevalence and incidence between countries, the incidence of RA-ILD in daily practice is low in our RA population from different continents. Patients with RA-ILD had a higher disease activity than patients without RA-ILD, and were more often ACPA positive and/or (former) smokers.

Keywords: Incidence; Interstitial lung disease; Rheumatoid arthritis; Worldwide.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: S.A. Bergstra reports financial support was provided by Merit Foundation. S.A. Bergstra reports a relationship with Pfizer that includes: funding grants. S.A. Bergstra reports a relationship with Benecke that includes: speaking and lecture fees. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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