Background: Rheumatoid arthritis (RA) is a ‘chronic autoimmune disorder’ commonly linked to ‘extra-articular’ complications, such as ‘interstitial lung disease (ILD)’, a severe condition that significantly increases both morbidity and mortality.However, in Pakistan, there is not enough data available regarding the ‘ILD prevalence and predictors in RA patients’ highlighting its clinical gap.This study aimed to determine the prevalence of ILD in RA patients and identify key demographic, clinical, and pulmonary predictors associated with its development. Methods: A cross-sectional study was carried out in the Department of Rheumatology, Lady Reading Hospital, Peshawar, from April 1, 2024, to September 30, 2024. A total of 246 RA patients were enrolled depending on inclusion of the study. Interviews, clinical assessment, pulmonary function tests and high-resolution CT scans were the methods of data collection. Statistical analysis focused on finding the relationships between ILD and several putative variables, a p-value of <0.05 was considered significant. Results: In the study subjects, shows the proportion of patients with ILD who had PFT abnormalities in 40.7% and 36.6% patients with chest imaging abnormalities. Such variables as age of 50 years and older (p = 0.03), smoking (p = 0.02), duration of the disease for ≥5 years (p = 0.04), high RA activity scores (p = 0.01), autoantibodies presence (p = 0.02) were significant predictors. Most of the patients reported low HRQoL, 48.8% of the studied patients with moderate HRQoL and 36.6% of severe fatigue. Conclusion: This research establishes a significant quantity of the disease burden of ILD in Pakistani RA patients and also finds out relevant factors, such as age, smoking, duration of disease, and activity of RA. Such findings need early recognition and management measures to reduce the burden of ILD in this sort of population.