Interstitial lung disease (ILD) remains a leading cause of mortality in rheumatoid arthritis (RA). Estimates of involvement of ILD in RA remain relatively imprecise (estimated prevalence 5-20%), though this partly reflects the wide spectrum of ILD and differing ascertainment.

The ability to prevent RA in individuals at risk is a holy grail in rheumatology. There is a long history dating back to the PROMPT trial of methotrexate and PRAIRIE trial of rituximab. Both otrials showed an effect, but it seemed more likely to be a delaying of RA than prevention or modulation. Framing it another way, there were better outcomes in pre-RA because we were actually treating RA as it emerged with a proven effective treatment. It is