How do you screen rheumatoid arthritis patients for lung disease (modality, frequency, patient selection)?

Theoretically, we are supposed to screen these patients obtaining a baseline chest X-ray before starting DMARD therapy. As I remember, these guidelines were formulated when MTX was still blamed for MTX lung disease although presently, even the presence of underlying ILD is not necessarily a contrain...

RA patients are usually not screened for ILD on initial diagnosis and evaluation. They may be screened if they have underlying risk factors of lung disease (asthma, COPD, or smoking). Once ILD is suspected, they follow ILD evaluation and management protocols.

The literature provides some guidance regarding ILD screening for RA. Risk factors are well known; male sex, Hx of smoking, high titer RF/CCP, older age, and disease activity. Given the prevalence of ILD in RA (8-10%) we should be asking about respiratory symptoms during visits with our RA patients....

I will screen if the patient has symptoms suggestive of lung disease.

I usually screen patients with a chest X-ray and send them for pulmonary function tests (PFTs) if they have a cough or shortness of breath. If they are smokers and have a cough, I try to avoid methotrexate.