How do you approach management of a patient with multiple lung nodules and low titer +CCP but no active joint symptoms suggestive of RA?

In the absence of other clinical symptomatology, I would favor close observation and follow-up in this case as there is no established diagnosis and repeat CT, PFT’s in 3 to 6 months. Details of initial evaluation should include PET-CT to exclude malignancy but also to investigate other organ system...

Agree with this approach. High CCP may not sway me either, but if it were an ILD case, I would then approach her as an IPAF (interstitial Pneumonitis with Autoimmune Features).