Approaches to screening for rheumatoid arthritis-associated interstitial lung disease: a cross-sectional national survey of Turkish rheumatologists.

OBJECTIVE

Rheumatoid arthritis-associated interstitial lung disease (RA-ILD) is a potentially life-threatening complication of RA, yet standardized screening guidelines are lacking. This study aimed to explore current screening practices among Turkish rheumatologists and assess how demographic and institutional factors influence clinical decision-making.

METHODS

An electronic survey was distributed to 550 members of the Turkish Society for Rheumatology between May and June 2024. The questionnaire included items on respondents' clinical experience, practice settings, estimated RA-ILD prevalence, screening criteria, and preferred diagnostic methods.

RESULTS

A total of 107 rheumatologists completed the survey (response rate: 20%). Most participants (59.8%) worked in university hospitals and 44.9% had ≤ 5 years of clinical experience. Over half (52.3%) estimated the frequency of RA-ILD in their patients to be 5-10%. Nearly half of the rheumatologists (47.7%) screened RA patients with respiratory symptoms. The three most frequently used screening methods were chest computed tomography (CT) (77.6%), chest X-ray (72.9%), and pulmonary function testing (PFT) (65.4%). While 20% of participants reported using only a single method for screening, the most preferred combination was chest X-ray, CT, PFT, and diffusing capacity of the lungs for carbon monoxide (DLCO), used by 20.6% of respondents. Compared to university hospitals, rheumatologists working in state hospitals reported fewer opportunities for pulmonary assessments, limited access to DLCO testing, less collaboration with experienced radiologists or pulmonologists, and a lack of multidisciplinary approaches.

CONCLUSION

Our study highlights the variability in disease assessment and clinical practices related to RA-ILD screening among rheumatologists. These findings underscore the need to standardize screening strategies, taking into account national healthcare conditions and the local working environments of rheumatologists.