Rheumatoid arthritis (RA) is an inflammatory autoimmune disease that can affect not only your joints, but also other parts of your body. As the disease progresses, it can even affect your organs — including your lungs.
We’ll explore the possible ways RA can affect your lungs. You can use this information to talk with a doctor about a treatment plan that works for you.
Interstitial lung disease refers to a group of diseases that scar lung tissue. Scarring can cause breathing problems due to the stiffening of the lungs and difficulty getting oxygen into the bloodstream.
Rheumatoid arthritis-associated interstitial lung disease (RA-ILD) can develop over time from RA-induced inflammation. As inflammation happens, the body starts attacking lung cells, leading to a type of widespread damage.
Lung scarring may lead to breathing difficulties and related symptoms. These symptoms include:
- shortness of breath
- chronic dry cough
- excessive fatigue
- reduced appetite
- unintentional weight loss
It’s likely that once you start experiencing symptoms, your lungs already have a significant amount of chronic inflammation.
However, the earlier you get diagnosed, the sooner you can start treatment to prevent disease progression and scarring. To make a diagnosis, a doctor will likely order lung function testing as well as an X-ray or CT scan of your lungs.
The best approach to addressing lung scarring from RA is to make sure your RA treatment is working. If the underlying inflammation is treated effectively, there’s a greater chance your healthy lung cells won’t be affected.
Corticosteroids may be prescribed in combination with other immunosuppressant drugs such as cyclosporine (Neoral) or cyclophosphamide (Cytoxan). Based on some research, however, it’s unclear if immunosuppressant drugs effectively treat RA-ILD.
New, highly effective antifibrotic (antiscarring) therapies are also available to help treat RA-ILD. They are pirfenidone (Esbriet) and nintedanib (Ofev).
Without treatment, lung scarring can be life threatening.
Pulmonary fibrosis is another form of interstitial lung disease that causes lung scarring. It’s a progressive disease that gets worse over time. There’s currently no cure.
Causes of pulmonary fibrosis range from autoimmune diseases to the environment to the unknown. The inflammation from RA is one of the triggers that may lead to pulmonary fibrosis. Up to 40 percent of people with RA develop pulmonary fibrosis.
Some symptoms of pulmonary fibrosis are:
- shortness of breath, which is usually the first symptom
- a chronic dry, hacking cough
- shallow breathing
- weakness and fatigue
- widening and rounding of the tips of your fingers and toes
As with RA-ILD, treatment for pulmonary fibrosis may include medications such as corticosteroids and other immunosuppressants. In some cases, oxygen therapy may be needed. In the most severe cases, a lung transplant may be necessary.
Nodules are solid, noncancerous masses that sometimes develop in the organs and other parts of the body.
Lung nodules are small, so they are not very noticeable. In fact, they’re usually no bigger than 1.2 inches (3 centimeters) in diameter.
Lung nodules that develop from RA, called pulmonary rheumatoid nodules, are rare. There may be multiple nodules in both lungs.
Pulmonary rheumatoid nodules occur more often in people who:
- are assigned male at birth
- are on prolonged treatment with methotrexate (Otrexup, Rasuvo)
Other risk factors include exposure to:
- occupational dust
Lung nodules typically do not have any noticeable symptoms. They’re often found while imaging tests are being done for other issues. A large mass or a mass with irregular edges may be a sign of lung cancer.
Because of a lack of clinical data, there’s currently no standard treatment for pulmonary rheumatoid nodules. Therefore, the treatment depends on your individual case.
B-cell targeted therapies such as rituximab (Rituxan) may be used to help shrink the nodules and reduce their number. In some cases, RA medications that are not as damaging to your lung tissue may be prescribed as an alternative to methotrexate.
If there’s a very high risk of the nodules rupturing or causing other complications, surgery may be needed to remove them.
As with lung scarring, the most effective way to prevent lung nodules caused by RA is to treat the underlying inflammation that’s bringing on these related issues.
Pleural disease occurs when the pleura (membrane), or soft tissue surrounding your lungs, becomes inflamed. Oftentimes, this type of lung inflammation occurs alongside fluid buildup between the lining around the lung tissue and the chest wall. This area is known as the pleural space.
In many cases, pleural disease is not severe enough to cause any symptoms. In fact, small fluid buildup may go away on its own. If there’s a large enough buildup, you may experience shortness of breath or pain while breathing and need treatment. Sometimes pleural disease can cause fever as well.
Large fluid buildup from pleural disease requires treatment to remove excess fluid. This is done with either a chest tube or a needle, which removes the fluids from the pleural space.
Treatment may be repeated as necessary if pleural disease causes more fluid buildup in the future.
Pleural disease cannot always be prevented, but in some cases, treating RA-related lung issues as early as possible may help. You can also avoid risk factors such as:
- drinking alcohol
- exposure to asbestos
RA can also lead to inflammation within the small airways of your lungs. Over time, chronic inflammation in this area can cause thickening in these airways and lead to mucus blockages in your lungs. This is known as small airway obstruction.
Other signs of small airway obstruction can include:
- dry cough
- shortness of breath
While RA treatments can prevent small airway obstruction, they do not offer immediate relief from this lung condition. Talk with a doctor about rescue inhalers or bronchodilators that can help open up the airways and make breathing smoother.
If you’re having difficulty breathing, rescue inhalers can be used occasionally for immediate relief. They contain fast-acting medications that quickly relax the muscles around your breathing passages. These medications include albuterol (ProAir HFA, Ventolin HFA) and levalbuterol (Xopenex, Xopenex HFA).
For everyday use, long-acting bronchodilators are inhaled medications that may help prevent breathlessness. Bronchodilators include:
Bronchodilators may be combined with a corticosteroid to also help reduce swelling in your lungs and breathing passages. These combined medications include budesonide/formoterol (Symbicort) and fluticasone/salmeterol (Advair).
Having RA is the primary contributor of developing RA-related lung diseases, but other risk factors can also increase your chances. These risk factors include:
- older age
- being assigned male at birth
- having more active or undertreated RA
- having anti-cyclic citrullinated peptide (anti-CCP) antibodies, which attack healthy cells
- damage to a portion of the lung known as the lung parenchyma (pulmonary parenchyma)
RA itself can shorten your life expectancy due to the complications from widespread inflammation.
Although people with RA may live into their 80s and 90s, if the disease is not effectively treated, life expectancy may decrease. According to a 2011 study, RA may reduce a person’s life expectancy by 3 to 10 years.
Complications such as lung disease are just some of the ways RA can decrease your overall life expectancy.
A 2016 study of women with and without RA suggests that RA is associated with a
A 2015 Canadian study also found that the mortality rate for people with RA was
Lung diseases alone can reduce your life expectancy because they can prevent the supply of vital oxygen to the rest of your organs and body tissues.
According to a 2015 study, lung disease makes up about
Managing your RA is just one way you can decrease the risk of related lung diseases.
You can also help keep your lungs healthy by:
It’s important to see a doctor for routine visits if possible. However, you do not want to wait for your regular visit if you’re experiencing new or unusual symptoms.
See your doctor about potential lung disease if you’re experiencing symptoms such as:
- painful breathing
- shortness of breath
- breathing difficulties, especially after physical activity
- chronic cough
- increased weakness and fatigue
- appetite changes
- sudden weight loss
- chronic fevers
Any breathing troubles should be addressed with a doctor immediately to prevent lung-related complications. The sooner your doctor knows about the symptoms you’re dealing with, the sooner they can diagnose and treat you for potential lung disease.