Introduction: Definite usual interstitial pneumonia (UIP) pattern on high-resolution computed tomography (HRCT) is very specific, but not sensitive, for UIP pattern on surgical lung biopsy in patients suspected of having idiopathic pulmonary fibrosis (IPF). We investigated whether definite UIP pattern on HRCT was specific for UIP pattern on histopathology in patients with rheumatoid arthritis associated interstitial lung disease (RA-ILD). Methods: Two radiologists reviewed HRCT scans patients with biopsy proven RA-ILD. The radiologists categorized the HRCT scans as definite, possible or inconsistent with UIP pattern using the ATS/ERS/JRS/ALAT criteria. We also determined the sensitivity and specificity of definite UIP pattern on HRCT to UIP pattern onhistopathology. Results: There were 69 patients with RA-ILD included in this study and were collected from 3 tertiary care centers: University of California San Francisco, Mayo Clinic, and Asan Medical Center. The frequency of histopathologic UIP pattern in this cohort was 61%. Men were more likely than women to have a UIP pattern on histopathology (p 0.02). The agreement between the 2 radiologists for definite UIP pattern was 87% (kappa 0.67, p value ＜0.0001). The specificity of UIP pattern on HRCT for histopathologic UIP pattern was 96% (95% CI 81%-100%), with a positive predictive value of 95%. The sensitivity of UIP pattern on HRCT for histopathologic UIP pattern was 45% (95% CI 30%-61%), with a negative predictive value of 53%. Conclusion: Definite UIP pattern on HRCT in patients with RA-ILD is highly specific, but not sensitive, to UIP pattern on histopathology. This is consistent with the literature in IPF.