Validation of the SER/SEPAR criteria for the screening of interstitial lung disease in a large cohort of patients with rheumatoid arthritis.

OBJECTIVE

To validate, in routine clinical practice, the SER/SEPAR criteria for the screening of rheumatoid arthritis (RA)-associated interstitial lung disease (ILD).

METHODS

A retrospective study was conducted in patients with RA who had undergone high-resolution computed tomography (HRCT) of the lungs within the past 5 years. Clinical and radiological variables were collected, and the proposed screening criteria were applied. Sensitivity and specificity of the overall algorithm, as well as of its individual components, were calculated.

RESULTS

A total of 270 patients were included (71% women), with a mean age of 64.3 years and a mean disease duration of 10.8 years. Among them, 58 patients (21.5%) had ILD on HRCT. Application of the SER/SEPAR criteria yielded a sensitivity of 96.5% and a specificity of 25%, recommending screening tests in 90% of patients and HRCT in 75% of them. The individual sensitivity of chest radiography and pulmonary function tests (PFTs) for the detection of ILD was low (≤50%) in both symptomatic and asymptomatic patients. The presence of lung crackles on lung auscultation was the finding with the highest specificity (92.9%).

CONCLUSION

The SER/SEPAR screening criteria show excellent sensitivity but low specificity, leading to the recommendation of diagnostic testing in the majority of patients. In our cohort, chest X-ray and PFTs demonstrated limited utility for ILD screening in patients with RA.