RA ILD Screening — SCE Rheumatology MCQ

Correct answer: D — Older age, male sex, smoking history, elevated RF or anti-CCP and high disease activity

Explanation lettering: C = shown as A · D = shown as B · E = shown as C · B = shown as D · A = shown as E

Option B is correct. The ERS/EULAR RA-ILD screening algorithm identifies older age, male sex, current or previous smoking, elevated RF, anti-CCP antibodies, increased inflammatory markers and high RA disease activity as risk factors. Their accumulation should increase suspicion and prompt risk-based ILD assessment even before overt respiratory symptoms develop. Options A and E predominantly describe lower-risk features. Options C and D mix recognised factors with characteristics not included as screening determinants in the guideline; methotrexate exposure alone is not an indication for RA-ILD screening. Respiratory symptoms or signs such as persistent cough, dyspnoea or inspiratory crackles would require diagnostic investigation rather than merely asymptomatic screening. Universal screening of every patient with RA is not currently established as standard UK practice.

Reference: Antoniou KM et al. ERS/EULAR clinical practice guidelines for connective tissue disease-associated interstitial lung disease, screening algorithm for ILD detection, 2026. https://pubmed.ncbi.nlm.nih.gov/40907995/