Prevalence of interstitial lung disease in patients with psoriatic arthritis: a systematic review and meta-analysis.

BACKGROUND

Interstitial lung disease (ILD) is not classically considered an extra-articular manifestation of psoriatic arthritis (PsA). However, emerging evidence suggests that pulmonary involvement may be more common than previously recognized. The prevalence of ILD in PsA remains poorly defined.

OBJECTIVES

To estimate the pooled prevalence of ILD among patients with PsA and to evaluate associated risk factors and comparative risk with other populations.

METHODS

We conducted a systematic review and meta-analysis registered in PROSPERO. MEDLINE (PubMed), EMBASE (Scopus), and the Cochrane Library were searched from inception to January 2026. Observational studies reporting ILD prevalence in PsA were included. Random-effects models with logit-transformed proportions were used to pool prevalence estimates. Subgroup analyses were performed based on ILD diagnostic method.

RESULTS

Six studies comprising 14,272 patients with PsA were included. The pooled prevalence of ILD was 3% (95% confidence interval [CI]: 1%-7%; I2 = 96.6%). Prevalence was significantly higher in studies using imaging-based diagnosis with computed tomography or high-resolution computed tomography (6%, 95% CI: 4%-10%; I2 = 55%) compared with studies relying on non-imaging identification (1%, 95% CI: 1%-11%; I2 = 0). The difference between subgroups was statistically significant (p < 0.0001). Smoking was associated with a significantly increased risk of ILD in PsA (pooled odds ratio 2.94, 95% CI: 1.22-7.12; I2 = 1.8%).

CONCLUSIONS

Interstitial lung disease affects a meaningful proportion of patients with psoriatic arthritis, particularly when imaging-based diagnostic methods are used. ILD may be underrecognized in routine clinical practice. Increased awareness, standardized diagnostic approaches, and prospective studies are needed to define optimal screening and management strategies for ILD in PsA. PROSPERO registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261278657 Key Points • Interstitial lung disease may be an underrecognized comorbidity in psoriatic arthritis. • The prevalence appears higher when imaging-based diagnostic methods are used.