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Objective <p>Interstitial lung disease (ILD) is a systemic complication in patients with rheumatoid arthritis (RA), significantly impacting morbidity and mortality. This study aims to evaluate clinical features and specific biomarkers associated with ILD to assist in identifying pulmonary involvement in the RA population.</p> Materials and methods <p>A cross-sectional observational study was conducted between July 2022 and December 2023 at a rheumatology centre. The study included patients diagnosed with RA-associated ILD (RA-ILD) and RA without ILD. The clinical features of RA-associated ILD were assessed using a multivariable logistic regression model to identify independent associates. The serum levels of Krebs von den Lungen-6 (KL-6) and Surfactant Protein-D (SP-D) were evaluated using enzyme-linked immunosorbent assay kits, following the manufacturer’s instructions.</p> Results <p>A total of 460 RA patients were screened, and 187 were included based on the study criteria. Out of which, 52 (27.8%) were RA-ILD, and 135 (72.2%) were RA without ILD. Univariate analysis of RA-ILD vs. RA without ILD showed that male sex, RA disease duration, Raynaud’s phenomenon (RP), dry mouth, dry cough, dyspnoea, and velcro crackles were the potential clinical features for RA-ILD. Multivariable logistic regression analysis revealed that RP (OR = 429.01, <i>P</i> &lt; 0.001), dyspnoea (OR = 13.55, <i>P</i> = 0.01), and velcro crackles (OR = 36.97, <i>P</i> &lt; 0.001) were significant clinical features associated with RA-ILD. This study also evaluated serum SP-D and KL-6 as biomarkers for ILD in 72 patients. Both biomarkers were significantly elevated in RA-ILD patients (<i>p</i> &lt; 0.0001) and served as independent biomarkers for the identification of pulmonary involvement in RA patients. ROC analysis demonstrated high diagnostic accuracy for KL-6 (AUC 0.975) and SP-D (AUC 0.974), with their combination yielding an AUC of 0.999. Despite their individual predictive power, SP-D and KL-6 showed no significant correlation within the RA-ILD group.</p> Conclusion <p>In this study, RP, dyspnoea, and velcro crackles were found to be strong clinical features of RA-ILD. While both KL-6 and SP-D are robust indicators of RA-ILD, they appear to involve distinct pathological pathways, as evidenced by their non-significant correlation within the disease cohort. These clinical findings highlight the utility of symptom assessment for identifying RA-ILD patients in clinical practice.</p>

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Identifying clinical features and biomarkers associated with interstitial lung disease in rheumatoid arthritis patients

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月28日

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  • Mahesh Rathod,
  • Preethi Chunduri,
  • Christy Thomas,
  • Sarvajeet Pal,
  • Rajeev Arab,
  • Nagarjuna Maturu,
  • Srishti Pal,
  • Bhupen Barman,
  • Krishna Undela

摘要

Objective

Interstitial lung disease (ILD) is a systemic complication in patients with rheumatoid arthritis (RA), significantly impacting morbidity and mortality. This study aims to evaluate clinical features and specific biomarkers associated with ILD to assist in identifying pulmonary involvement in the RA population.

Materials and methods

A cross-sectional observational study was conducted between July 2022 and December 2023 at a rheumatology centre. The study included patients diagnosed with RA-associated ILD (RA-ILD) and RA without ILD. The clinical features of RA-associated ILD were assessed using a multivariable logistic regression model to identify independent associates. The serum levels of Krebs von den Lungen-6 (KL-6) and Surfactant Protein-D (SP-D) were evaluated using enzyme-linked immunosorbent assay kits, following the manufacturer’s instructions.

Results

A total of 460 RA patients were screened, and 187 were included based on the study criteria. Out of which, 52 (27.8%) were RA-ILD, and 135 (72.2%) were RA without ILD. Univariate analysis of RA-ILD vs. RA without ILD showed that male sex, RA disease duration, Raynaud’s phenomenon (RP), dry mouth, dry cough, dyspnoea, and velcro crackles were the potential clinical features for RA-ILD. Multivariable logistic regression analysis revealed that RP (OR = 429.01, P < 0.001), dyspnoea (OR = 13.55, P = 0.01), and velcro crackles (OR = 36.97, P < 0.001) were significant clinical features associated with RA-ILD. This study also evaluated serum SP-D and KL-6 as biomarkers for ILD in 72 patients. Both biomarkers were significantly elevated in RA-ILD patients (p < 0.0001) and served as independent biomarkers for the identification of pulmonary involvement in RA patients. ROC analysis demonstrated high diagnostic accuracy for KL-6 (AUC 0.975) and SP-D (AUC 0.974), with their combination yielding an AUC of 0.999. Despite their individual predictive power, SP-D and KL-6 showed no significant correlation within the RA-ILD group.

Conclusion

In this study, RP, dyspnoea, and velcro crackles were found to be strong clinical features of RA-ILD. While both KL-6 and SP-D are robust indicators of RA-ILD, they appear to involve distinct pathological pathways, as evidenced by their non-significant correlation within the disease cohort. These clinical findings highlight the utility of symptom assessment for identifying RA-ILD patients in clinical practice.