{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T14:04:38Z","timestamp":1790949878961,"version":"4.1.0"},"reference-count":32,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T00:00:00Z","timestamp":1772150400000},"content-version":"unspecified","delay-in-days":26,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100001009","name":"Bristol Myers Squibb Foundation","doi-asserted-by":"publisher","award":["IM101-839"],"award-info":[{"award-number":["IM101-839"]}],"id":[{"id":"10.13039\/100001009","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100001003","name":"Boehringer Ingelheim","doi-asserted-by":"publisher","award":["2020_00002458"],"award-info":[{"award-number":["2020_00002458"]}],"id":[{"id":"10.13039\/100001003","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Resp Res"],"accepted":{"date-parts":[[2026,2,7]]},"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Rheumatoid arthritis-associated interstitial lung disease (RA-ILD) is heterogeneous. Forced vital capacity (FVC) decline and high-resolution CT (HRCT) pattern are widely used as prognostic markers, but the natural history of RA-ILD identified in rheumatology clinics, particularly in mild disease, remains insufficiently described.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a prospective, multicentre cohort study across three Brazilian centres. Adults with RA-ILD were followed every 6\u2009months for 24 months. Pulmonary function tests, HRCT, 6\u2009min walk test and King\u2019s Brief Interstitial Lung Disease health-related quality-of-life questionnaire were performed at baseline, 12 and 24 months. Blood biomarkers were assessed at baseline, 6 and 18 months. HRCT scans were independently reviewed by two chest radiologists and analysed using densitometry-based quantitative CT (QCT). Pulmonary fibrosis was qualitatively defined by unequivocal traction bronchiectasis and\/or honeycombing on HRCT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Ninety-five subjects were included (mean age 63\u00b110 years; 81% female). Pulmonary fibrosis was present in 80%, although only 20% were classified as definite or probable usual interstitial pneumonia (\u03ba=0.52). Individuals with fibrosis had lower FVC (75%\u00b117 vs 86%\u00b115, p=0.02) and worse QCT measures (%high-attenuation areas \u2212600 to \u2212250 HU 12.1\u00b16.6 vs 5.5\u00b10.8, p&lt;0.001; lung volume 3407\u00b1958\u2009mL vs 4077\u00b1923\u2009mL, p=0.015). In 24 months, FVC and QCT measures remained stable. Eight subjects (8%) died. Deaths were not preceded by measurable functional or radiological decline. Health-related quality-of-life scores and blood biomarkers remained unchanged.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this predominantly mild RA-ILD cohort, pulmonary function and QCT metrics remained stable over 2 years despite an 8% mortality rate. The absence of preceding decline in conventional prognostic markers suggests potential limitations of current monitoring strategies, although our findings should be interpreted as hypothesis-generating.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT04136223\">NCT04136223<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjresp-2025-003973","type":"journal-article","created":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T14:35:31Z","timestamp":1772202931000},"page":"e003973","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Functional, radiological and survival outcomes in rheumatoid arthritis-associated interstitial lung disease: 24-month results from the BERTHA prospective cohort"],"prefix":"10.1136","volume":"13","clinical-trial-number":[{"clinical-trial-number":"nct04136223","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0784-1331","authenticated-orcid":false,"given":"Leticia","family":"Kawano-Dourado","sequence":"first","affiliation":[{"name":"HCor Research Institute, Hospital do Coracao, Sao Paulo, Brazil"},{"name":"Pulmonary Division, Heart Institute (InCor), Universidade de Sao Paulo, Sao Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karina","family":"Bonfiglioli","sequence":"additional","affiliation":[{"name":"Rheumatology Division, Hospital das Clinicas HCFMUSP, Universidade de S\u00e3o Paulo, Sao Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana C M","family":"Ribeiro","sequence":"additional","affiliation":[{"name":"Rheumatology Division, Hospital das Clinicas HCFMUSP, Universidade de S\u00e3o Paulo, Sao Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8182-5121","authenticated-orcid":false,"given":"Licia Maria Henrique da","family":"Mota","sequence":"additional","affiliation":[{"name":"Hospital Universit\u00e1rio de Bras\u00edlia da Universidade de Bras\u00edlia, EBSERH (HUB-UnB), Bras\u00edlia, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0444-738X","authenticated-orcid":false,"given":"Alisson","family":"Pugliesi","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Rheumatology and Traumatology, Campinas State University (UNICAMP), Campinas, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luciana","family":"Muniz","sequence":"additional","affiliation":[{"name":"Rheumatology Division, Hospital S\u00edrio-Liban\u00eas, Brasilia, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel G","family":"Strabelli","sequence":"additional","affiliation":[{"name":"Institute of Radiology (InRad), Hospital das Clinicas HCFMUSP, Universidade de S\u00e3o Paulo, Sao Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea Y","family":"Shimabuco","sequence":"additional","affiliation":[{"name":"Rheumatology Division, Hospital das Clinicas HCFMUSP, Universidade de S\u00e3o Paulo, Sao Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luciana","family":"Louren\u00e7oni","sequence":"additional","affiliation":[{"name":"Hospital Universit\u00e1rio de Bras\u00edlia da Universidade de Bras\u00edlia, EBSERH (HUB-UnB), Bras\u00edlia, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1926-1150","authenticated-orcid":false,"given":"Fernanda L F B A","family":"Riscado","sequence":"additional","affiliation":[{"name":"Hospital Universit\u00e1rio de Bras\u00edlia da Universidade de Bras\u00edlia, EBSERH (HUB-UnB), Bras\u00edlia, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra Gofinet","family":"Pasoto","sequence":"additional","affiliation":[{"name":"Rheumatology Division, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cleando P","family":"Albuquerque","sequence":"additional","affiliation":[{"name":"Hospital Universit\u00e1rio de Bras\u00edlia da Universidade de Bras\u00edlia, EBSERH (HUB-UnB), Bras\u00edlia, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4738-1440","authenticated-orcid":false,"given":"Luis F","family":"Marqueze","sequence":"additional","affiliation":[{"name":"LABOX, Department of Biochemistry, Federal University of Santa Catarina, Florianopolis, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1144-5326","authenticated-orcid":false,"given":"Romuel","family":"Barros Costa Silva","sequence":"additional","affiliation":[{"name":"LABOX, Department of Biochemistry, Federal University of Santa Catarina, Florianopolis, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luciana C","family":"Palhares","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Rheumatology and Traumatology, Campinas State University (UNICAMP), Campinas, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana C","family":"Londe","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Rheumatology and Traumatology, Campinas State University (UNICAMP), Campinas, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0538-9820","authenticated-orcid":false,"given":"Juliana 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