---
title: "Guideline differences in rheumatoid arthritis-associated interstitial lung disease care"
id: "pubmed-42888356"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42888356"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42888356/"
doi: "10.1007/s00296-026-06322-x"
published_at: "2026-10-17T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Guideline differences in rheumatoid arthritis-associated interstitial lung disease care
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42888356
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42888356/)
- **DOI:** [10.1007/s00296-026-06322-x](https://doi.org/10.1007%2Fs00296-026-06322-x)
- **Published At:** 2026-10-17T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- The authors performed a narrative comparative review of five guideline groups: ERS/EULAR, ACR/CHEST, EULAR, PANLAR, and ALAT. They compared recommendations across screening, diagnosis, monitoring, and treatment. - Diagnostic guidance showed strongest agreement: the guideline groups favored **HRCT**, **pulmonary function tests**, and multidisciplinary evaluation for suspected or established **RA-ILD**. - Screening approaches differed: ERS/EULAR and ACR/CHEST recommended risk-based assessment, while ALAT proposed broader screening that included lung ultrasound as an adjunct without replacing HRCT. - Monitoring intervals varied; ACR/CHEST recommended pulmonary function testing every 3–12 months in the first year and HRCT when clinically indicated, whereas ERS/EULAR suggested PFTs every 3–6 months in early years and periodic HRCT. - Treatment recommendations diverged most: ACR/CHEST conditionally recommended mycophenolate, rituximab, azathioprine, and cyclophosphamide as first-line ILD therapies; ALAT emphasized integrated control of articular and pulmonary disease with abatacept or rituximab. - EULAR and PANLAR focused mainly on articular RA therapy and did not issue dedicated RA-ILD treatment algorithms, according to the review. - Antifibrotic therapy was discussed primarily for progressive fibrosing disease across guidelines, not as universal first-line therapy. - The investigators reported that differences reflect guideline scope, methodology, and limited RA-ILD–specific evidence; they called for prospective comparative studies to harmonize care.
## Clinical Analysis & Structured Key Points
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Affiliations Expand ### Affiliations * 1 Hospital Italiano de La Plata, Universidad Nacional de La Plata (UNLP), calle 51 N° 1725, 1900, La Plata, Buenos Aires, Argentina. gsalinasrodrigo@gmail.com. * 2 Universidad Autónoma de Aguascalientes, Aguascalientes, Mexico. * 3 Hospital Universitario Austral, Buenos Aires, Argentina. * 4 Instituto de Rehabilitación Psicofísica (IREP), Ciudad Autónoma de Buenos Aires (CABA), Argentina. * 5 Instituto de Enfermedades Intersticiales-Hospital Británico de Buenos Aires, Ciudad Autónoma de Buenos Aires (CABA), Argentina. * 6 Biomab-Centro de Artritis Reumatoide, Bogotá, Colombia. * 7 Hospital Cetrangolo, Florida, Provincia de Buenos Aires, Argentina. * 8 Hospital Alemán, Ciudad Autónoma de Buenos Aires (CABA), Argentina. * 9 Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain. * PMID: **42888356** * DOI: [ 10.1007/s00296-026-06322-x ](https://doi.org/10.1007/s00296-026-06322-x) Item in Clipboard Review # Divergent approaches to rheumatoid arthritis-associated interstitial lung disease: a comparative analysis of international clinical practice guidelines Rodrigo Garcia-Salinas et al. Rheumatol Int. 2026. Show details Display options Display options Format Abstract PubMed PMID Rheumatol Int Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Rheumatol+Int%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Rheumatol+Int%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42888356/) . 2026 Oct 17;46(11):291. doi: 10.1007/s00296-026-06322-x. ### Authors [Rodrigo Garcia-Salinas](https://pubmed.ncbi.nlm.nih.gov/?term=Garcia-Salinas+R&cauthor_id=42888356)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42888356/#short-view-affiliation-1 "Hospital Italiano de La Plata, Universidad Nacional de La Plata \(UNLP\), calle 51 N° 1725, 1900, La Plata, Buenos Aires, Argentina. gsalinasrodrigo@gmail.com."), [Mario Chávez-Lopez](https://pubmed.ncbi.nlm.nih.gov/?term=Ch%C3%A1vez-Lopez+M&cauthor_id=42888356)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42888356/#short-view-affiliation-2 "Universidad Autónoma de Aguascalientes, Aguascalientes, Mexico."), [Ramiro A Gómez](https://pubmed.ncbi.nlm.nih.gov/?term=G%C3%B3mez+RA&cauthor_id=42888356)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42888356/#short-view-affiliation-3 "Hospital Universitario Austral, Buenos Aires, Argentina."), [María Otaola](https://pubmed.ncbi.nlm.nih.gov/?term=Otaola+M&cauthor_id=42888356)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42888356/#short-view-affiliation-4 "Instituto de Rehabilitación Psicofísica \(IREP\), Ciudad Autónoma de Buenos Aires \(CABA\), Argentina."), [Silvia Quadrelli](https://pubmed.ncbi.nlm.nih.gov/?term=Quadrelli+S&cauthor_id=42888356)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42888356/#short-view-affiliation-5 "Instituto de Enfermedades Intersticiales-Hospital Británico de Buenos Aires, Ciudad Autónoma de Buenos Aires \(CABA\), Argentina."), [Pedro Santos-Moreno](https://pubmed.ncbi.nlm.nih.gov/?term=Santos-Moreno+P&cauthor_id=42888356)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42888356/#short-view-affiliation-6 "Biomab-Centro de Artritis Reumatoide, Bogotá, Colombia."), [Gabriela Tabaj](https://pubmed.ncbi.nlm.nih.gov/?term=Tabaj+G&cauthor_id=42888356)[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42888356/#short-view-affiliation-7 "Hospital Cetrangolo, Florida, Provincia de Buenos Aires, Argentina."), [Brenda Elena Varela](https://pubmed.ncbi.nlm.nih.gov/?term=Varela+BE&cauthor_id=42888356)[ 8 ](https://pubmed.ncbi.nlm.nih.gov/42888356/#short-view-affiliation-8 "Hospital Alemán, Ciudad Autónoma de Buenos Aires \(CABA\), Argentina."), [Ricardo Blanco Alonso](https://pubmed.ncbi.nlm.nih.gov/?term=Blanco+Alonso+R&cauthor_id=42888356)[ 9 ](https://pubmed.ncbi.nlm.nih.gov/42888356/#short-view-affiliation-9 "Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain.") ### Affiliations * 1 Hospital Italiano de La Plata, Universidad Nacional de La Plata (UNLP), calle 51 N° 1725, 1900, La Plata, Buenos Aires, Argentina. gsalinasrodrigo@gmail.com. * 2 Universidad Autónoma de Aguascalientes, Aguascalientes, Mexico. * 3 Hospital Universitario Austral, Buenos Aires, Argentina. * 4 Instituto de Rehabilitación Psicofísica (IREP), Ciudad Autónoma de Buenos Aires (CABA), Argentina. * 5 Instituto de Enfermedades Intersticiales-Hospital Británico de Buenos Aires, Ciudad Autónoma de Buenos Aires (CABA), Argentina. * 6 Biomab-Centro de Artritis Reumatoide, Bogotá, Colombia. * 7 Hospital Cetrangolo, Florida, Provincia de Buenos Aires, Argentina. * 8 Hospital Alemán, Ciudad Autónoma de Buenos Aires (CABA), Argentina. * 9 Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain. * PMID: **42888356** * DOI: [ 10.1007/s00296-026-06322-x ](https://doi.org/10.1007/s00296-026-06322-x) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID Linked Discoveries ## Abstract 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. **Keywords:** Interstitial lung diseases; Practice guidelines as topic; Pulmonary fibrosis; Rheumatoid arthritis; X-ray computed tomography. © 2026. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement 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 1. 1. Aletaha D, Smolen JS (2018) Diagnosis and Management of Rheumatoid Arthritis: A Review. JAMA 320:1360–1372. - [DOI](https://doi.org/10.1001/jama.2018.13103) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/30285183/) 2. 1. Kadura S, Raghu G (2021) Rheumatoid arthritis-interstitial lung disease: Manifestations and current concepts in pathogenesis and management. Eur Respir Rev 30:210011. - [DOI](https://doi.org/10.1183/16000617.0011-2021) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/34168062/) - [PMC](https://pmc.ncbi.nlm.nih.gov/articles/9489133/) 3. 1. Laria A, Lurati AM, Zizzo G et al (2022) Interstitial Lung Disease in Rheumatoid Arthritis: A Practical Review. Front Med (Lausanne) 9:837133. - [DOI](https://doi.org/10.3389/fmed.2022.837133) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/35646974/) - [PMC](https://pmc.ncbi.nlm.nih.gov/articles/9136053/) 4. 1. Wang HF, Wang YY, Li ZY et al (2024) The prevalence and risk factors of rheumatoid arthritis-associated interstitial lung disease: a systematic review and meta-analysis. Ann Med 56:2332406. - [DOI](https://doi.org/10.1080/07853890.2024.2332406) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/38547537/) - [PMC](https://pmc.ncbi.nlm.nih.gov/articles/10984230/) 5. 1. Gochuico BR, Avila NA, Chow CK et al (2008) Progressive preclinical interstitial lung disease in rheumatoid arthritis. Arch Intern Med 168:159–166. - [DOI](https://doi.org/10.1001/archinternmed.2007.59) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/18227362/) Show all 47 refer
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