Background: there is increasing evidence to indicate that autoimmunity as well as inflammatory reactions occur systemically before development of any clinical sign of joint disease in patients with anti–citrullinated protein antibody (ACPA)–positive rheumatoid arthritis (RA). Objective: The aim of the work was to investigate the potential predictive value of anti-ccp3 for interstitial lung disease association with RA and to discriminate RA patient who are at potential risk to develop methotrexate (MTX) induced pulmonary toxicity. Patients and methods: This cross-sectional study included a total of 50 RA patients who were diagnosed according to the 2010 American College of Rheumatology / the European League Against Rheumatism classification criteria for Rheumatoid Arthritis (ACR/EULAR 2010 criteria) for detection of pulmonary manifestations attending at Physical medicine, Rheumatology and Rehabilitation Outpatient Clinics of Al-Azhar University Hospitals. Results: there was statistically significant difference between patients with and without interstitial lung disease (ILD), in high-resolution computed tomography (HRCT) as regards to Tiffeneau-Pinelli index (FEV1/FVC ratio), except for FEV1/FVC between patients with and without ILD in HRCT, forced expiratory volume in first second (FEV1), and forced vital capacity (FVC) are often decreased because of the reduction in lung volume, but the FEV1- to-FVC ratio is maintained or increased in ILD. Conclusion: RA patients without chest symptoms should not be neglected, pulmonary function testing and HRCT should be done routinely to pick up early ILD cases.