This study explores whether the prognosis of interstitial lung disease in rheumatoid arthritis (RA-ILD) has improved over time and assesses the potential influence of drug therapy in a large multicentre UK network. We analysed data from 18 UK centres on patients meeting criteria for both RA and ILD diagnosed over a 25-year period. Data included age, disease duration, outcome and cause of death. We compared all cause and respiratory mortality between RA controls and RA-ILD patients, assessing the influence of specific drugs on mortality in four quartiles based on year of diagnosis. A total of 290 RA-ILD patients were identified. All cause (respiratory) mortality was increased at 30% (18%) compared with controls 21% (7%) (P =0.02). Overall, prognosis improved over quartiles with median age at death rising from 63 years to 78 years (P =0.01). No effect on mortality was detected as a result of DMARD use in RA-ILD. Relative risk (RR) of death from any cause was increased among patients who had received anti-TNF therapy [2.09 (1.1–4.0)] P =0.03, while RR was lower in those treated with rituximab [0.52(0.1–2.1)] or mycophenolate [0.65 (0.2–2.0)]. Patients receiving rituximab as their first biologic had longer three (92%), five (82%) and seven year (80%) survival than those whose first biologic was an anti-TNF agent (82%, 76% and 64%, respectively) (P =0.037). This large retrospective multicentre study demonstrates survival of patients with RA-ILD has improved. This may relate to the increasing use of specific immunosuppressive and biologic agents.

Objective: Interstitial lung disease (ILD) is one of the commonest systemic complications in patients with rheumatoid arthritis (RA) and carries a significant morbidity and mortality burden. We aimed to identify key variables to risk-stratify RA patients in order to identify those at increased risk of developing ILD. We propose a probability score based on the identification of these variables. Methods: A retrospective, multicentre study using clinical data collected between 2010 and 2020, across 20 centres. Results: A total of 430 RA (210 with ILD confirmed on high-resolution computed tomography (HRCT)) patients were evaluated. We explored several independent variables for the risk of developing ILD in RA and found that the key significant variables were smoking (past or present), older age and positive rheumatoid factor/anti-cyclic citrullinated peptide. Multivariate logistic regression models were used to form a scoring system for categorising patients into high and low risk on a scale of 0–9 points and a cut-off score of 5, based on the area under the receiver operating characteristic curve of 0.76 (CI 95% 0.71–0.82). This yielded a sensitivity of 86% and a specificity of 58%. High-risk patients should be considered for investigation with HRCT and monitored closely. Conclusion: We have proposed a new model for identifying RA patients at risk of developing ILD. This approach identified four simple clinical variables: age, anti-cyclic citrullinated peptide antibodies, Rheumatoid factor and smoking, which allowed development of a predictive scoring system for the presence of ILD in patients with RA.

Fibromyalgia and joint hypermobility are common coexisting conditions among younger females that are often accompanied with additional features of autonomic dysfunction. Mental health is frequently impacted with these conditions and an association with neurodivergence has been recently established. Neurodivergence is also prevalent among close relatives. Reasons for this association are poorly understood, although genetics, adverse early life experiences and autoimmunity all contribute. Pharmacological responses may differ in neurodivergence, while psychological support requires adaptation for individual sensitivities. Screening patients with fibromyalgia and hypermobility for neurodivergent traits and vice versa may facilitate diagnosis and management.

Chronic musculoskeletal pain is an increasingly frequent feature in young people. Many exhibit a range of additional physical and psychological features and fulfil criteria for fibromyalgia. Hypermobility, irritable bowel syndrome and migraine are frequent comorbid conditions. These are all in part mediated by dysfunction of the autonomic nervous system and commonly include fatigue, poor sleep and brain fog. Anxiety, social withdrawal and a range of autistic traits are frequently described by those with chronic musculoskeletal pain, and autistic people are over-represented among patients attending pain clinics. This study was designed to explore the correlation between the degree of pain and autistic traits described within a self-selected community-based population. The study used a nonexperimental, correlational design with data collected from a volunteer sample of 448 adults (aged 18-60) who completed online self-report questionnaires assessing each of autistic traits (RAADS-R score), fibromyalgia symptoms (ACR criteria) and hypermobility (Beighton’s test). Correlation analysis and linear regressions were used to test the relationships between each disorder. Data was analysed using parametric and non-parametric techniques to assess prevalence, strength and significance of relationships, causes of variance within populations and mediations. Our self-selected community population had a mean age of 24 years and was 77% female. The prevalence of significant autistic traits, fibromyalgia and hypermobility were all much greater than expected at 63.4%, 40.6% and 43.7% respectively. Those identifying as non-binary or trans had the highest rates. Fibromyalgia was significantly associated with autistic traits, with dysautonomia a stronger predictor than chronic pain. Regression analyses revealed hypermobility partially mediated the relationship between autistic traits and fibromyalgia. This is the first community study to provide evidence for a direct association between fibromyalgia and autistic traits. Although self-selected, the findings in our predominantly young female population confirm that these conditions are common and that those with autistic traits are at significantly increased risk of developing fibromyalgia, especially if they are hypermobile.

Interstitial lung disease (ILD) is a significant complication of many systemic autoimmune rheumatic diseases (SARDs), although the clinical presentation, severity and outlook may vary widely between individuals. Despite the prevalence, there are no specific guidelines addressing the issue of screening, diagnosis and management of ILD across this diverse group. Guidelines from the ACR and EULAR are expected, but there is a need for UK-specific guidelines that consider the framework of the UK National Health Service, local licensing and funding strategies. This article outlines the intended scope for the British Society for Rheumatology guideline on the diagnosis and management of SARD-ILD developed by the guideline working group. It specifically identifies the SARDs for consideration, alongside the overarching principles for which systematic review will be conducted. Expert consensus will be produced based on the most up-to-date available evidence for inclusion within the final guideline. Key issues to be addressed include recommendations for screening of ILD, identifying the methodology and frequency of monitoring and pharmacological and non-pharmacological management. The guideline will be developed according to methods and processes outlined in Creating Clinical Guidelines: British Society for Rheumatology Protocol version 5.1.