Rheumatoid arthritis (RA) can affect more than just the joints. Discover lung-related conditions and symptoms, such as interstitial lung disease, lung nodules, and small airway obstruction.
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 internal organs — including your lungs.
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 can scar lung tissue. Scarring can cause breathing problems due to the stiffening of the lungs and the difficulty in getting oxygen into the bloodstream.
Rheumatoid arthritis-associated interstitial lung disease (RA-ILD) can develop over time as a result of RA-induced inflammation. As inflammation occurs, the body starts attacking lung cells, leading to a type of widespread damage.
RA-ILD occurs in about 5% to 10% of people with RA, according to a 2019 study.
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 your lungs will already have a significant amount of chronic inflammation by the time you start experiencing symptoms.
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 a high-resolution CT (HRCT) 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.
Management of RA-ILD may include:
- lifestyle changes, such as:
- quitting smoking, if you smoke
- decreasing your exposure to air pollution
- minimizing respiratory allergens like animal dander
- eating an anti-inflammatory diet
- performing cardiopulmonary exercises, which strengthen the heart and lungs
- losing weight, if you have overweight
- antifibrotic (antiscarring) therapies, such as pirfenidone (Esbriet) or nintedanib (Ofev)
- treatment of any infections
- administration of vaccines to protect against lung infections such as pneumonia and the flu
- oxygen therapy, if you’re dealing with a lot of weakness and a reduced quality of life
- evaluation for a lung transplant
A lung transplant may be recommended as a last resort for more severe cases.
Without treatment, lung scarring can be life threatening.
Pulmonary fibrosis, or severe lung scarring, can occur in some people with RA. It’s a progressive disease that gets worse over time. There’s no cure at the moment.
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.
Some symptoms of pulmonary fibrosis are:
- shortness of breath, which is usually the first symptom
- shallow breathing
- a chronic dry, hacking cough
- weakness and fatigue
- clubbing, or widening and rounding, of the tips of your fingers and toes
Treatment for pulmonary fibrosis may include medications such as corticosteroids, other immunosuppressants, and antifibrotic drugs. 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’re 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, or dust in the workplace
Lung nodules don’t typically have any noticeable symptoms. They’re often found while imaging tests are being performed 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 aren’t 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 (membranes), or soft tissues surrounding your lungs, become inflamed. Oftentimes, this type of lung inflammation occurs alongside fluid buildup between the chest wall and the lining around the lung tissue. This area is known as the pleural space.
In many cases, pleural disease isn’t severe enough to cause any symptoms. In fact, a small amount of fluid buildup may go away on its own. If there’s enough buildup, you may experience shortness of breath or pain while breathing and need treatment. Sometimes pleural disease can cause fever as well.
A large amount of fluid buildup from pleural disease also requires treatment to remove excess fluid. This is done with either a chest tube or a needle, removing the fluids from the pleural space.
Treatment may be repeated as necessary if pleural disease causes more fluid buildup in the future.
Pleural disease can’t always be prevented, but 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 mucous blockages in your lungs. This is known as small airway obstruction.
Symptoms of small airway obstruction can include:
- wet or dry cough
- shortness of breath
While RA treatments can prevent small airway obstruction, they don’t 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, Proventil HFA, Ventolin HFA)
- levalbuterol (Xopenex, Xopenex HFA)
For everyday use, long-acting bronchodilators may help prevent breathlessness. These inhaled medications include:
- formoterol (Perforomist)
- salmeterol (Serevent)
- tiotropium (Spiriva)
Bronchodilators may be combined with a corticosteroid to also help reduce swelling in your lungs and breathing passages. These combined medications include:
Having RA is the primary contributor to the development of RA-related lung diseases, but other factors can also increase your risk. These risk factors include:
- older age
- being assigned male at birth
- having more active or undertreated RA
- having high levels of rheumatoid factor autoantibodies or anti-cyclic citrullinated peptide (anti-CCP) autoantibodies, which may 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, life expectancy may decrease if the disease isn’t effectively treated. According to an older 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 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.
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 don’t want to wait for your regular visit if you’re experiencing new or unusual symptoms.
See a 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 fever
Any breathing troubles should be addressed with a doctor immediately to prevent lung-related complications. The sooner a doctor knows about the symptoms you’re dealing with, the sooner they can diagnose and treat you for potential lung disease.