Current Diagnostic Pathways for Rheumatoid Arthritis-Associated Interstitial Lung Disease Result in Substantial Underdiagnosis and Excess Mortality: A Multicenter Norwegian Quality Assurance Audit.

Eirik Ikdahl; Benedikte D&#xf8;skeland; Liv Turid Bertelsen; Gunnstein Bakland; Tina Therese Pedersen; Yi Hu; Phuong Phuong Diep; Lene Maria Sundbakk; Sella Aarrestad Provan; Anna-Maria Hoffmann-Vold

doi:10.1016/j.jbspin.2026.106130

PubMed · 42679991

Current Diagnostic Pathways for Rheumatoid Arthritis-Associated Interstitial Lung Disease Result in Substantial Underdiagnosis and Excess Mortality: A Multicenter Norwegian Quality Assurance Audit.

Eirik Ikdahl·Benedikte Døskeland·Liv Turid Bertelsen·Gunnstein Bakland·Tina Therese Pedersen·Yi Hu·Phuong Phuong Diep·Lene Maria Sundbakk·Sella Aarrestad Provan·Anna-Maria Hoffmann-Vold

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Abstract

OBJECTIVE: Recent guidelines suggest risk-stratified screening for rheumatoid arthritis-associated interstitial lung disease (RA-ILD). However, the diagnostic gap between current routine care and this screening approach remains unquantified. We assessed currently detected RA-ILD in Norway, benchmarking findings against recent screening-based estimates of the true disease burden. METHODS: This 10-year quality assurance audit across six centers covered 43% of the Norwegian population. RA-ILD cases identified via ICD-10 codes were confirmed by manual chart review. Prevalence was calculated relative to a registry-derived total RA background population and benchmarked against a 10% expected target derived from recent prospective studies. Mortality was compared to a 3:1 frequency-matched RA control group using Cox proportional hazards regression. RESULTS: Among 17,305 RA patients, 188 (1.1%) had verified ILD; when benchmarked against an expected 10% prevalence, this indicates an 89% diagnostic gap in routine clinical care. Mean age at ILD detection was 67.5 years. Most cases (93.6%) possessed ≥2 established risk factors for RA-ILD: 93.6% were seropositive, 76.1% had smoking histories, while RA onset age ≥60 and persistently increased inflammatory laboratory markers were present in over half of patients. RA-ILD was associated with significantly increased mortality; 66 (4.1/100 person-years) deaths occurred in the RA-ILD group vs. 120 (2.3/100 person-years) among RA controls (HR 1.77; 95% CI: 1.31-2.39, p<0.001). CONCLUSION: When comparing to prevalence expectations, current routine care may leave a substantial proportion of cases undetected, primarily capturing a high-risk phenotype with excess mortality. Systematic, risk-stratified screening is needed to bridge this diagnostic gap, aiming to enable earlier intervention.

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Interstitial lung disease Rheumatoid arthritis Risk factors Screening Journal Article

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Eirik Ikdahl, Benedikte Døskeland, Liv Turid Bertelsen, Gunnstein Bakland, Tina Therese Pedersen, Yi Hu, Phuong Phuong Diep, Lene Maria Sundbakk, Sella Aarrestad Provan, Anna-Maria Hoffmann-Vold. 2026-09-01. Current Diagnostic Pathways for Rheumatoid Arthritis-Associated Interstitial Lung Disease Result in Substantial Underdiagnosis and Excess Mortality: A Multicenter Norwegian Quality Assurance Audit.. https://doi.org/10.1016/j.jbspin.2026.106130

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