FIGURE 4.

Suggested diagnostic approach for management of lung disease progression versus pulmonary infection or toxicity induced by disease-modifying anti-rheumatic drugs (DMARDs) in a patient with pre-existing rheumatoid arthritis-associated interstitial lung disease (RA-ILD). HRCT: high-resolution computed tomography; GGOs: ground-glass opacities; BAL: bronchoalveolar lavage; TBBx: transbronchial lung biopsy; SLB: surgical lung biopsy. ^#: transbronchial biopsy or cryobiopsy, as per the treating clinician and/or multidisciplinary discussion; elective SLB in patients may be considered if TBBx and/or cryobiopsy is non-diagnostic in patients who are stable and are not at high risk for surgical complications.