Academic Journal
Divergent approaches to rheumatoid arthritis-associated interstitial lung disease: a comparative analysis of international clinical practice guidelines.
| Τίτλος: | Divergent approaches to rheumatoid arthritis-associated interstitial lung disease: a comparative analysis of international clinical practice guidelines. |
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| Συγγραφείς: | Garcia-Salinas R; Hospital Italiano de La Plata, Universidad Nacional de La Plata (UNLP), calle 51 N° 1725, 1900, La Plata, Buenos Aires, Argentina. gsalinasrodrigo@gmail.com., Chávez-Lopez M; Universidad Autónoma de Aguascalientes, Aguascalientes, Mexico., Gómez RA; Hospital Universitario Austral, Buenos Aires, Argentina., Otaola M; Instituto de Rehabilitación Psicofísica (IREP), Ciudad Autónoma de Buenos Aires (CABA), Argentina., Quadrelli S; Instituto de Enfermedades Intersticiales-Hospital Británico de Buenos Aires, Ciudad Autónoma de Buenos Aires (CABA), Argentina., Santos-Moreno P; Biomab-Centro de Artritis Reumatoide, Bogotá, Colombia., Tabaj G; Hospital Cetrangolo, Florida, Provincia de Buenos Aires, Argentina., Varela BE; Hospital Alemán, Ciudad Autónoma de Buenos Aires (CABA), Argentina., Blanco Alonso R; Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain. |
| Πηγή: | Rheumatology international [Rheumatol Int] 2026 Oct 17; Vol. 46 (11). Date of Electronic Publication: 2026 Oct 17. |
| Τύπος έκδοσης: | Journal Article; Comparative Study; Review |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Springer International Country of Publication: Germany NLM ID: 8206885 Publication Model: Electronic Cited Medium: Internet ISSN: 1437-160X (Electronic) Linking ISSN: 01728172 NLM ISO Abbreviation: Rheumatol Int Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: [Berlin ; New York, NY] : Springer International, c1981- |
| Ιατρικοί όροι (MeSH): | Lung Diseases, Interstitial*/diagnosis , Lung Diseases, Interstitial*/etiology , Lung Diseases, Interstitial*/drug therapy , Lung Diseases, Interstitial*/therapy , Arthritis, Rheumatoid*/complications , Arthritis, Rheumatoid*/drug therapy , Arthritis, Rheumatoid*/diagnosis , Practice Guidelines as Topic*/standards, Humans ; Tomography, X-Ray Computed ; Respiratory Function Tests |
| Περίληψη: | Rheumatoid arthritis-associated interstitial lung disease (RA-ILD) is associated with substantial morbidity and mortality. We compared international and regional clinical practice guidelines to identify agreement, differences, and gaps in RA-ILD care. We conducted a narrative comparative review of five guideline groups: ERS/EULAR, ACR/CHEST, EULAR, PANLAR, and ALAT. Recommendations were assessed across screening, diagnosis, monitoring, and treatment, together with their methodological approaches. Diagnostic recommendations showed the greatest agreement: ILD-focused guidelines emphasized high-resolution computed tomography (HRCT), pulmonary function tests, and multidisciplinary evaluation. Screening recommendations differed: ERS/EULAR and ACR/CHEST favored risk-based assessment, whereas ALAT proposed a broader approach that included lung ultrasound as an adjunct, without replacing HRCT. For established RA-ILD, ACR/CHEST suggested, as implementation guidance, pulmonary function testing every 3-12 months during the first year and HRCT when clinically indicated; ERS/EULAR proposed pulmonary function testing every 3-6 months in the first years and periodic HRCT. Treatment showed the greatest divergence. ACR/CHEST conditionally recommended mycophenolate, rituximab, azathioprine, and cyclophosphamide as first-line ILD therapies, whereas ALAT emphasized integrated control of articular and pulmonary disease, particularly with abatacept or rituximab. EULAR and PANLAR primarily addressed RA treatment and did not provide dedicated RA-ILD algorithms. Antifibrotic treatment was considered mainly in progressive fibrosing disease. Guidelines converge on HRCT-based evaluation but differ in screening, monitoring intervals, and treatment priorities. These differences reflect their scope, methodology, and limited RA-ILD-specific evidence. Prospective comparative studies are needed to inform more consistent care. (© 2026. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.) |
| Competing Interests: | Declarations. Conflict of interest: RGS has received speaker fees from AbbVie, Novartis, Janssen, Pfizer, Lilly, and Sandoz, and consulting fees from AbbVie and Janssen. RGS is an author of the PANLAR recommendations for the management of rheumatoid arthritis and of the ALAT guideline on RA-ILD, both analyzed in this manuscript. PSM has received research support from Pfizer, Novartis, and Bristol Myers Squibb; speaker fees from Novartis, Amgen, and Janssen; and has participated in advisory boards for Bristol Myers Squibb, Amgen, Biopas, and UCB. PSM is an author of the PANLAR recommendations analyzed in this manuscript. SQ, MO, BV, and GT have received speaker fees and/or participated in advisory activities for Adium, Boehringer Ingelheim, Bagó, and Tuteur. MO has participated in clinical research for Boehringer Ingelheim, Bristol Myers Squibb, Sanofi, and United Therapeutics. GT has participated in clinical research for Boehringer Ingelheim, Bristol Myers Squibb, Vicore, Sanofi, and United Therapeutics, and in advisory boards for Boehringer Ingelheim, Bristol Myers Squibb, Knight, and Adium. BV has also received speaker fees and/or participated in advisory activities for Finadiet and Roche. The remaining authors declare no conflicts of interest or have disclosures to be confirmed. Declaration of AI-assisted editing: ChatGPT (OpenAI) was used from May to September 2026 to assist with language editing, manuscript structure, wording of responses to reviewers, and reference formatting. Codex based on GPT-6 was used during the September 2026 revision. All AI-assisted suggestions incorporated into the manuscript were reviewed and revised by the authors. The authors verified the scientific statements and bibliographic references, approved the final text, and take full responsibility for its accuracy, integrity, and originality. Disclaimer: This review is an original work, has not been published previously, and is not under consideration elsewhere. No text has been copied from other publications without appropriate quotation or attribution. AI-assisted tools were disclosed above; the authors reviewed and revised any AI-assisted wording and are responsible for all analyses, interpretations, conclusions, and final text. |
| References: | Semin Arthritis Rheum. 2026 Jun;78:152973. (PMID: 41990460) Lancet Rheumatol. 2026 Jan;8(1):e53-e65. (PMID: 41240967) Clin Rheumatol. 2020 May;39(5):1493-1499. (PMID: 31933033) Arthritis Rheumatol. 2024 Aug;76(8):1201-1213. (PMID: 38973714) Clin Rheumatol. 2025 Aug;44(8):3167-3175. (PMID: 40555925) Front Med (Lausanne). 2022 May 13;9:837133. (PMID: 35646974) Joint Bone Spine. 2024 Dec;91(6):105790. (PMID: 39389412) J Rheumatol. 2026 Apr 1;53(4):362-375. (PMID: 41326168) Lancet Respir Med. 2020 May;8(5):453-460. (PMID: 32145830) Expert Rev Respir Med. 2024 Jun;18(6):447-456. (PMID: 38943279) Eur Respir Rev. 2021 Jun 23;30(160):. (PMID: 34168062) Chest. 2025 Jun;167(6):1687-1695. (PMID: 39675519) J Clin Med. 2025 May 25;14(11):. (PMID: 40507462) J Clin Epidemiol. 2011 Apr;64(4):383-94. (PMID: 21195583) Rheumatology (Oxford). 2019 Feb 1;58(2):e3-e42. (PMID: 30137552) Ann Rheum Dis. 2016 Jan;75(1):3-15. (PMID: 25969430) J Clin Epidemiol. 2011 Apr;64(4):395-400. (PMID: 21194891) Rheumatol Int. 2025 Jan 18;45(2):34. (PMID: 39825929) Eur Respir J. 2021 Feb 11;57(2):. (PMID: 32646919) Semin Arthritis Rheum. 2025 Dec;75:152881. (PMID: 41275572) Semin Respir Crit Care Med. 2024 Jun;45(3):329-341. (PMID: 38484788) Arch Intern Med. 2008 Jan 28;168(2):159-66. (PMID: 18227362) Clin Rheumatol. 2021 Jul;40(7):2913-2920. (PMID: 33449230) Rheumatol Int. 2026 Aug 4;46(8):. (PMID: 42550264) Rheumatol Int. 2025 Oct 15;45(11):252. (PMID: 41091209) Ann Rheum Dis. 2026 Jan;85(1):22-60. (PMID: 40912974) Lancet Respir Med. 2026 Sep;14(9):820-836. (PMID: 42248165) Arthritis Care Res (Hoboken). 2024 Aug;76(8):1051-1069. (PMID: 38973731) Expert Rev Pharmacoecon Outcomes Res. 2023 Jul-Dec;23(6):619-623. (PMID: 37185151) Ann Med. 2024 Dec;56(1):2332406. (PMID: 38547537) Am J Respir Crit Care Med. 2022 May 1;205(9):e18-e47. (PMID: 35486072) Ann Rheum Dis. 2026 Jun;85(6):991-1009. (PMID: 41826212) Adv Rheumatol. 2021 Aug 24;61(1):52. (PMID: 34429162) JAMA. 2018 Oct 02;320(13):1360-1372. (PMID: 30285183) Respir Res. 2025 Nov 26;26(1):331. (PMID: 41299487) Eur Respir J. 2010 Jun;35(6):1322-8. (PMID: 19996193) Eur Respir J. 2016 Feb;47(2):588-96. (PMID: 26585429) Curr Opin Pulm Med. 2025 Sep 1;31(5):476-483. (PMID: 40643573) |
| Contributed Indexing: | Keywords: Interstitial lung diseases; Practice guidelines as topic; Pulmonary fibrosis; Rheumatoid arthritis; X-ray computed tomography |
| Entry Date(s): | Date Created: 20261016 Date Completed: 20261017 Latest Revision: 20261027 |
| Update Code: | 20261027 |
| DOI: | 10.1007/s00296-026-06322-x |
| PMID: | 42888356 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1437-160X |
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| DOI: | 10.1007/s00296-026-06322-x |