Abstract
Rheumatoid arthritis is a multisystem autoimmune inflammatory disease that typically presents as a case of arthritis that can later progress to involve multiple organs. Interstitial lung disease is one of the many extra-articular manifestations of rheumatoid arthritis. We discuss a case of rheumatoid arthritis that presented with interstitial lung disease prior to the development of arthritis along with the discussion of novel anti-carbamylated protein antibody as a serological marker for the diagnosis of seronegative rheumatoid arthritis.