Pulmonary lesions are a relatively common complication in patients with RA, in addition to joint lesions, and often coexist with the RA condition. Interstitial lung disease (ILD) is a progressive fibrotic lesion of the lung parenchyma that resolves spontaneously in some patients, while most patients present with progressive pulmonary fibrosis leading to respiratory failure. the prevalence of RA-associated ILD is approximately 19% to 44%, and the objective prevalence may be higher than available data due to differences in diagnostic and reporting criteria. the symptoms of RA-associated ILD are usually not apparent at the onset of the disease. ILD tends to have a poor prognosis, with an average survival of about 3 years after diagnosis, and despite significant advances in treatment and diagnostic measures over the past 30 years, the survival of ILD has not improved significantly. In a study called the Early Rheumatoid Arthritis Study (ERAS), Gouri Koduri, an academic at the University of Hertfordshire in the United Kingdom, followed subjects for 23 years to examine the relationship between ILD and RA. was explored in depth. From 1986 to 1998, the study included a total of 1,460 RA patients from nine medical centers in the United Kingdom. During the follow-up period, ILD occurred in a total of 52 patients, of whom 43 (2.9%) were clinically diagnosed and 9 (0.6%) were autopsy-confirmed. 86% of patients with RA-related ILD were treated with DMARDs, compared with 84% of patients without ILD. SSZ and MTX were the most commonly used DMARDs. 12 of these ILD patients had ILD diagnosed at The annual incidence of ILD was 4.1 per 1,000 and the 15-year cumulative incidence was 62.9 per 1,000. Those who were older, had higher ESR levels, and higher baseline HAQ values were at higher risk of developing ILD. Multivariate regression analysis showed that only age and baseline ESR levels were significantly associated with the risk of developing ILD. each 10-year increase in RA age was associated with a 64% increase in the risk of ILD, and each 10-unit increase in ESR was associated with an 11% increase in risk. Of these 52 ILD patients, 39 died during follow-up, accounting for 7% of the total. Of these, 28 died from ILD and no patients died from malignant diseases such as lung cancer. There was also no evidence that MTX was associated with death from ILD. 5 of the 9 patients with advanced disease or ILD diagnosed at autopsy died within 1 year of diagnosis. the mean survival time after ILD diagnosis was 3 years, with a 5-year survival rate of 38.8%. age at diagnosis of ILD was associated with death, with a 53% increased risk of death without a 10-year increase. The risk of death was also higher in patients with lower socioeconomic levels. The effect of biologics on ILD could not be evaluated because none of these patients were on biologics. The investigators stated that ILD is a lesion that is present early in RA disease and is associated with RA disease. the higher the RA activity, the greater the risk of developing ILD and the worse the prognosis. In addition to cardiovascular disease, ILD is a significant cause of death in patients with RA. The early detection rate of ILD can be improved by performing lung lesion screening such as HRCT.