Perceptions, Practices in RA-ILD Differ Between Rheumatologists and Pulmonologists

Pulmonary fibrosis of rheumatoid arthritis
Pulmonary fibrosis of rheumatoid arthritis
There are significant differences in perceptions of prevalence, risk factors, and the management of RA-associated interstitial lung disease between rheumatologists and pulmonologists.

This article is part of Pulmonology Advisor’s coverage of the American Thoracic Society Virtual 2020 meeting.

There are significant differences in perceptions of prevalence, risk factors, and the management of rheumatoid arthritis (RA)-associated interstitial lung disease (ILD) between rheumatologists and pulmonologists, according to study results presented virtually at American Thoracic Society (ATS) 2020, held from August 5 to 10, 2020.

To assess the perceptions and practice patterns in RA-ILD between rheumatologists and pulmonologists, researchers developed 2 surveys with questions about prevalence, risk factors, diagnosis, management, and prognosis of patients with RA-ILD. The surveys included 44 questions that were distributed to rheumatologists and pulmonologists by email, social media, and the European Scleroderma Trials and Research Group network.

Researchers received anonymous responses from 616 participants (57% rheumatologists; 43% pulmonologists) from more than 15 countries. They noted significant differences in the survey responses between rheumatologists and pulmonologists in terms of prevalence of ILD in RA (2% prevalence, 27% vs 6.5%, respectively; P <.0001) and risk factors for RA-ILD, including high titer rheumatoid factor/anticyclic citrullinated peptide (P <.0001), smoking status (P =.0022), and methotrexate use (P =.0797).

While treatment options for RA-ILD were similar between the 2 groups, rheumatologists compared with pulmonologists were more likely to prescribe rituximab and less likely to prescribe adalimumab and leflunomide. Although only ~25% considered methotrexate use as a risk factor, researchers noted that 60% avoided prescribing methotrexate for RA-ILD.

Survey findings also indicated that years of practice influenced perceptions of prevalence and medications for RA-ILD among both rheumatologists and pulmonologists. Compared with providers in academic settings or tertiary referral centers, individuals in private practices were less likely to prescribe certain disease-modifying antirheumatic drugs and more likely to consider corticosteroids as effective treatment options for RA-ILD (64% vs 75%; P =.015).

Researchers concluded, “Given the potential emergence of newer therapies for RA-ILD, these data highlight the need for clinical guidelines in the diagnosis and management of RA-ILD.”


Solomon J, Kreuter M, Polke M, Aronson KI, Hoffmann-Vold A, Dellaripa P. The knowledge and practices of rheumatologists and pulmonologists in rheumatoid arthritis-associated interstitial lung disease. Presented at: American Thoracic Society 2020 Virtual; August 5-10, 2020. Abstract #P533.

Visit Pulmonology Advisor‘s conference section for continuous coverage from ATS Virtual 2020.