{
  "abstract": "Objectives To evaluate the validity of the rheumatoid arthritis–interstitial lung disease screening project of the Spanish Society of Rheumatology (AR-EPIDSER) screening criteria for detecting rheumatoid arthritis (RA)-associated interstitial lung disease (ILD) and to estimate the prevalence of undiagnosed and subclinical ILD in patients with RA in Spain.Patients and methods Multicentre cross-sectional observational study conducted in 15 Spanish hospitals. Adult patients with RA (American College of Rheumatology (ACR) 1987 or ACR/European Alliance of Associations for Rheumatology 2010 criteria) without a previous ILD diagnosis were included. During a rheumatology visit, the AR-EPIDSER screening criteria were applied, and all participants underwent high-resolution CT (HRCT) of the chest as the reference test, with centralised reading. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were estimated with 95% CI as well as the prevalence of ILD and subclinical ILD.Results A total of 477 patients were recruited; 424 had evaluable HRCT (73.6% women; median age 59 years). The prevalence of ILD on HRCT examinations was 13.0% (55/424; 95% CI 9.9% to 16.6%). Subclinical ILD (no cough, dyspnoea or ‘Velcro-like’ crackles) was 8.3% (35/424; 95% CI 5.7% to 11.1%), accounting for 63.6% of ILD cases. Screening was positive in 68.2% (289/424). The AR-EPIDSER criteria showed sensitivity=0.93 (95% CI 0.82 to 0.98), specificity=0.36 (0.31 to 0.41), PPV=0.18 (0.13 to 0.23) and NPV=0.97 (0.93 to 0.99).Conclusion In Spanish patients with RA, undiagnosed ILD is frequent and mostly subclinical. The AR-EPIDSER criteria are useful as an initial screening tool due to high sensitivity and excellent NPV; however, low specificity suggests that positive cases should be confirmed by HRCT.",
  "authors": [
    {
      "affiliations": [
        "Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), Málaga, Spain"
      ],
      "name": "Natalia Mena-Vázquez"
    },
    {
      "affiliations": [
        "Research Unit, Sociedad Española de Reumatología, Madrid, Spain"
      ],
      "name": "Marta Domínguez-Álvaro"
    },
    {
      "affiliations": [
        "Rheumatology Service, Hospital Universitario La Paz, IdiPAZ, Madrid, Universidad Autónoma de Madrid, Madrid, Spain"
      ],
      "name": "María Gema Bonilla Hernán"
    },
    {
      "affiliations": [
        "Rheumatology Service, Immunopathology Group, Department of Medicine and Psychiatry, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain"
      ],
      "name": "Belén Atienza-Mateo"
    },
    {
      "affiliations": [
        "Radiodiagnostic Service, GRUHPAZ, Grupo de Hipertensión Pulmonar, Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain"
      ],
      "name": "María Fernández Velilla Peña"
    },
    {
      "affiliations": [
        "Radiodiagnostic Service, Hospital Universitario La Paz, IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain"
      ],
      "name": "Inmaculada Pinilla Fernández"
    },
    {
      "affiliations": [
        "Rheumatology Service, Hospital Universitario La Princesa, IIS-Princesa, Madrid, Spain"
      ],
      "name": "Ana M Ortiz"
    },
    {
      "affiliations": [
        "Rheumatology Service, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain"
      ],
      "name": "Hye Sang Park"
    },
    {
      "affiliations": [
        "Rheumatology Service, Hospital Universitario de Vigo, Grupo de Estudio IRIDIS (Investigación en Reumatología y Enfermedades Inmunomediadas), Instituto de Investigación Sanitaria de Galicia Sur (IISGS), Vigo, Spain"
      ],
      "name": "Nair Pérez Gomez"
    },
    {
      "affiliations": [
        "Rheumatology Service, Hospital Universitario La Paz, IdiPAZ, Madrid, Universidad Autónoma de Madrid, Madrid, Spain"
      ],
      "name": "Chamaida Plasencia-Rodríguez"
    },
    {
      "affiliations": [
        "Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA Plataforma BIONAND), Málaga, Spain"
      ],
      "name": "Maria Carmen Aguilar Hurtado"
    },
    {
      "affiliations": [
        "Rheumatology Service, Hospital Universitari Germans Trias i Pujol, Badalona, Spain"
      ],
      "name": "Susana Holgado Pérez"
    },
    {
      "affiliations": [
        "Rheumatology Service, Immunopathology Group, Department of Medicine and Psychiatry, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain"
      ],
      "name": "Ana Serrano-Combarro"
    },
    {
      "affiliations": [
        "Rheumatology, Hospital Universitario Galdakao-Usansolo, Bizkaia",
        "Biobizkaia Health Research Institute, Osakidetza",
        "Euskal Herriko Unibertsitatea, Bizkaia, Spain"
      ],
      "name": "Nuria Vegas-Revenga"
    },
    {
      "affiliations": [
        "Rheumatology Service, Hospital Marina Baixa, Alicante, Spain"
      ],
      "name": "José Antonio Bernal Vidal"
    },
    {
      "affiliations": [
        "Rheumatology Service, Hospital Universitari Doctor Peset, Valencia, Spain"
      ],
      "name": "Joaquín Lacasa-Molina"
    },
    {
      "affiliations": [
        "Rheumatology Service, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain"
      ],
      "name": "Stefanie Burger"
    },
    {
      "affiliations": [
        "Rheumatology and Bone Metabolism Service, Hospital General Universitario de Valencia, Valencia, Spain"
      ],
      "name": "Cristina Campos Fernández"
    },
    {
      "affiliations": [
        "Rheumatology Service, Hospital Universitari Son Espases, Baleares, Spain"
      ],
      "name": "Jordi Fiter Aresté"
    },
    {
      "affiliations": [
        "Rheumatology Service, Hospital del Mar, Barcelona, Spain"
      ],
      "name": "Juan Antonio Meraz Ostiz"
    },
    {
      "affiliations": [
        "Rheumatology Service, Hospital Universitario Torrecárdenas, Almería, Spain"
      ],
      "name": "María del Mar Muñoz Gómez"
    },
    {
      "affiliations": [
        "Instituto de Investigación Sanitaria Hospital de Octubre (imas12), Madrid, Spain"
      ],
      "name": "Diego Alvaredo"
    },
    {
      "affiliations": [
        "Rheumatology Service, Hospital Universitario La Princesa, IIS-Princesa, Madrid, Spain",
        "Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Madrid, Spain"
      ],
      "name": "Santos Castañeda"
    },
    {
      "affiliations": [],
      "name": "on behalf of the VAR-EPIDSER Project Collaborating Group"
    }
  ],
  "title": "Validation of screening criteria for interstitial lung disease in rheumatoid arthritis in routine clinical practice: the VAR-EPIDSER study",
  "uid": "bebe4dc7-43f1-56a2-9420-a3bda87a004b"
}