skip to main content

RA-ILD — RACP Adult Medicine MCQ

Instant feedback + full explanation. One question, done properly.

HardRheumatologyRA-ILDRACP Adult Medicine

A 42-year-old woman with known anti-CCP positive rheumatoid arthritis on methotrexate 25 mg weekly develops a persistent dry cough and exertional dyspnoea. HRCT shows usual interstitial pneumonia (UIP) pattern with honeycombing. PFTs show restrictive defect with reduced DLCO. What should be the initial pharmacological approach?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Commence pirfenidone or nintedanib

RA-associated ILD with a UIP pattern behaves similarly to IPF and benefits from antifibrotic therapy. The TRAIL1 trial showed pirfenidone slowed FVC decline in RA-ILD with progressive fibrosis. Nintedanib also demonstrated benefit in progressive fibrosing ILD (INBUILD trial). Methotrexate and leflunomide can themselves cause pneumonitis and should be reviewed. Immunosuppression alone is insufficient for established UIP-pattern fibrosis.

Reference: eTG – 2025 – Rheumatology; TSANZ – 2023 – CTD-ILD Position Statement