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Medical records were used to confirm clinical ILD diagnoses by chest imaging or lung biopsy pathology reports. A combined three\u2010biomarker score (range 0\u20133) was calculated based on the presence of the\n                      <jats:italic>MUC5B<\/jats:italic>\n                      variant and elevations (upper 25% vs lower 75%) in MMP\u20107 and anti\u2010MAA antibody concentrations. Multivariate logistic and Cox regression models were adjusted for clinical risk factors.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 2,043 participants with RA, prevalent ILD was identified in 88 (88.7% male; mean age 63.6 years). The odds of prevalent RA\u2010ILD were higher with increased biomarker score (adjusted odds ratio 12.21 [95% confidence interval (CI) 3.82\u201338.97] for score of 3 vs 0). A score \u22651 had 76.1% sensitivity but 48.6% specificity. Incident RA\u2010ILD developed in 148 participants, with those having a combined biomarker score of 3 having the highest risk (adjusted hazard ratio 4.36 [95% CI 1.55\u201312.27]). The area under the curve for prevalent RA\u2010ILD and Harrell's C for incident RA\u2010ILD were highest when clinical risk factors were combined with the biomarker score.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This three\u2010analyte biomarker score was associated with both prevalent and incident RA\u2010ILD, improving risk stratification beyond clinical risk factors. Although this score is inadequate for clinical implementation, these findings demonstrate the potential for biomarker scores in RA\u2010ILD risk stratification.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acr.70008","type":"journal-article","created":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T06:51:23Z","timestamp":1765781483000},"page":"1016-1023","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Combining Three Peripheral Blood Biomarkers to Stratify Rheumatoid Arthritis\u2013Associated Interstitial Lung Disease Risk"],"prefix":"10.1002","volume":"78","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-2342-306X","authenticated-orcid":false,"given":"Kelsey","family":"Coziahr","sequence":"first","affiliation":[{"name":"Veterans Affairs (VA) Nebraska\u2010Western Iowa Health Care System  Omaha"},{"name":"University of Nebraska Medical Center  Omaha"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8816-7782","authenticated-orcid":false,"given":"Austin M.","family":"Wheeler","sequence":"additional","affiliation":[{"name":"Veterans Affairs (VA) Nebraska\u2010Western Iowa Health Care System  Omaha"},{"name":"University of Nebraska Medical Center  Omaha"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6717-9680","authenticated-orcid":false,"given":"Brent A.","family":"Luedders","sequence":"additional","affiliation":[{"name":"Veterans Affairs (VA) Nebraska\u2010Western Iowa Health Care System  Omaha"},{"name":"University of Nebraska Medical Center  Omaha"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Duryee","sequence":"additional","affiliation":[{"name":"Veterans Affairs (VA) Nebraska\u2010Western Iowa Health Care System  Omaha"},{"name":"University of Nebraska Medical Center  Omaha"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1752-0949","authenticated-orcid":false,"given":"Halie","family":"Frideres","sequence":"additional","affiliation":[{"name":"Veterans Affairs (VA) Nebraska\u2010Western Iowa Health Care System  Omaha"},{"name":"University of Nebraska Medical Center  Omaha"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8707-7649","authenticated-orcid":false,"given":"Katherine D.","family":"Wysham","sequence":"additional","affiliation":[{"name":"VA Puget Sound Health Care System  Seattle Washington"},{"name":"University of Washington  Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6640-9173","authenticated-orcid":false,"given":"Grant W.","family":"Cannon","sequence":"additional","affiliation":[{"name":"Salt Lake City VA Health Care System  Salt Lake City Utah"},{"name":"University of Utah  Salt Lake City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary","family":"Kunkel","sequence":"additional","affiliation":[{"name":"Salt Lake City VA Health Care System  Salt Lake City Utah"},{"name":"University of Utah  Salt Lake City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1387-0860","authenticated-orcid":false,"given":"Dana P.","family":"Ascherman","sequence":"additional","affiliation":[{"name":"Pittsburgh VA Health Care System  Pittsburgh Pennsylvania"},{"name":"University of Pittsburgh  Pittsburgh Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4937-0515","authenticated-orcid":false,"given":"Paul A.","family":"Monach","sequence":"additional","affiliation":[{"name":"VA Boston Health Care  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4930-3235","authenticated-orcid":false,"given":"Gail S.","family":"Kerr","sequence":"additional","affiliation":[{"name":"Washington DC VA Medical Center  Washington DC"},{"name":"Georgetown University  Washington DC"},{"name":"Howard University  Washington DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas M.","family":"Reimold","sequence":"additional","affiliation":[{"name":"Dallas VA Medical Center  Dallas Texas"},{"name":"University of Texas Southwestern  Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott M.","family":"Matson","sequence":"additional","affiliation":[{"name":"Kansas University Medical Center  Kansas City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua F.","family":"Baker","sequence":"additional","affiliation":[{"name":"Corporal Michael J. 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