ABS0814 EARLY DETECTION OF INTERSTITIAL LUNG DISEASE (ILD) IN PATIENTS WITH RHEUMATOID ARTHRITIS: APPLICATION OF A NEW SCREENING ALGORITHM

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Background: Interstitial lung disease (ILD) is one of the most important extra-articular manifestations of rheumatoid arthritis (RA), with variable frequency reported in the literature. A new algorithm based on risk factors using the Delphi methodology has been designed for the early detection of lung disease in patients with rheumatoid arthritis [1]. Objectives: The use of the algorithm in the early diagnosis of ILD in patients with rheumatoid arthritis and its correlation with clinical and laboratory parameters. Methods: A prospective, observational study was conducted on fifty-five patients with rheumatoid arthritis. Data on demographics, seropositivity, disease activity, and lung auscultation findings were collected. The screening algorithm for ILD was applied. Receiver Operating Characteristic (ROC) curves were constructed and the Area Under the Curve (AUC) with corresponding 95% confidence interval was calculated using DeLong method. Results: Among all patients, 51.8% were smokers. Additionally, 58% were receiving treatment with csDMARD and 75% with b/tsDMARD (Table 1). The algorithm recommended high-resolution chest computed tomography (HRCT) in 36 patients and spirometry in 10. Among them, 38% (n=11) had findings consistent with ILD. Patients with ILD had statistically significant frequency of Velcro sounds and ACPA levels (>3 times the Upper Limit of Normal [ULN]), with a median ILD screening score that was 2.4 times higher compared to those without ILD. The ILD screening score was strongly correlated with ILD (r = 0.53, p<0.001) and ACPA levels>3 ULN. Additionally, the algorithm demonstrated excellent predictive ability with an AUC of 0.85. Using a score of 7 as the optimal cutoff point determined by Youden's index, the sensitivity was 83,3% (95% CI 47.9-100%) and the specificity was 74,3% (95% CI 51.4-90%). Conclusion: The algorithm is a reliable predictive tool for ILD in patients with rheumatoid arthritis, contributing to early diagnosis and treatment. REFERENCES: [1] Narváez J, Aburto M, Seoane-Mato D, Bonilla G, Acosta O, Candelas G, et al Screening criteria for interstitial lung disease associated to rheumatoid arthritis: Expert proposal based on Delphi methodology. Reumatol Clin. 2023; 19:74–81. Figure 1A. Receiver Operator Characteristics (ROC) curve. The algorithm demonstrated excellent discriminatory ability in predicting ILD, with an AUC of 0.851. The cutoff of 7 points provides an optimal balance between sensitivity (83.3%; 95% CI 47.9-100%) and specificity (74.3%; 95% CI 51.4-90%). B. Table showing the correlation between clinical and laboratory characteristics. The ILD-screening score was strongly correlated with the presence of ILD (r = 0.53, p<0.001). Higher levels of ACPA, more than 3 times the upper limit of normal (ULN) were most strongly associated with ILD, (r = 0.46, p < 0.05). Smoking, with a high number of pys, was more common among men (r = 0.32, p < 0.05). Table 1Descriptive characteristics of patients included in the study based on the presence of interstitial lung disease.CharacteristicsTotal, N=47 1 ILD, N=12 1 Without ILD, N=35 1 p-value 2 Age65 (14)70 (8)64 (16)0.3Male Sex16 (34%)6 (50%)10 (29%)0.3Velcro crackles15 (32%)7 (58%)8 (23%)0.034Cough-dyspnea9 (19%)3 (25%)6 (17%)0.7Smoking <20 pys *8 (17%)1 (8.3%)7 (20%)0.7Smoking >20 pys*16 (34%)7 (58%)9 (26%)0.075Moderate/High DAS2816 (34%)5 (42%)11 (31%)0.7Rf > 3 ULN26 (57%)8 (67%)18 (53%)0.4ACPA (<3 ULN)3 (6.7%)0 (0%)3 (9.1%)0.6ACPA (>3 ULN)17 (38%)9 (75%)8 (24%)0.004Family History of ILD2 (4.3%)1 (8.3%)1 (2.9%)0.4Disease duration> 5years33 (72%)10 (83%)23 (68%)0.5Algorithm score5.57 (2.63)7.92 (1.62)4.77 (2.43)<0.001GCs use11 (24%)2 (17%)9 (26%)0.7csDMARD use26 (57%)7 (58%)19 (56%)0.9b/ts DMARD use35 (74%)9 (75%)26 (74%)>0.9 1 Mean (SD); n(% ) 2 Pearson's Chi-squared test; T-test *pys: pack-years **ULN: (Upper Limit of Normal ) Acknowledgements: NIL . Disclosure of Interests: None declared . © The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.

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