Rheumatoid arthritis (RA) is commonly thought of as a disease that affects the joints. However, RA can also affect the lungs, and symptoms of rheumatoid lung disease can begin before joint pain. About 1 in 10 people with RA will develop lung problems.
One myRAteam member wrote about her experience with RA and rheumatoid lung disease: “I can’t do simple stretches and it’s hard to breathe and sleep.” Shortness of breath and other respiratory symptoms from RA-related lung disease can be serious complications. Here’s what you need to know about lung problems in RA, including approaches for treatment and prevention.
RA is an autoimmune disease, which means your body’s immune system attacks normal body tissue. Chronic inflammation from the attacks can lead to swelling, scarring, and pain in the body.
Your immune system normally attacks outside invaders like bacteria by creating antibodies, which serve as markers and flags for certain antigens (identifying molecules on the invaders’ surface). In autoimmune diseases like RA, your body creates antibodies against its antigens, causing the immune system to attack different parts of the body. In RA, these autoimmune antibodies are called rheumatoid factor (RF) and anti-CCP.
The same inflammatory agents can affect other organs within the body, which make them also susceptible to autoimmune attack. This is why 40 percent of people with RA will have symptoms outside of their joints, including in the lungs.
Specific to the lungs, RA can lead to scarring of the small airways inside the lung tissue, leading to RA-related interstitial lung disease (RA-ILD), lung nodules, and high blood pressure in the arteries between the heart and lungs, among other conditions.
Normally, small air sacs in your lungs expand when you breathe in. In healthy lungs, the walls of these sacs are thin enough to allow oxygen to flow into blood vessels. In RA-ILD, these walls become scarred and thickened to the point where oxygen cannot get in (much like trying to blow into a really thick balloon) and it becomes hard to breathe.
People who have interstitial lung disease related to RA often find themselves short of breath. They may also have a dry cough that does not go away, as well as fatigue, weakness, and loss of appetite.
Similarly, shortness of breath and fatigue can also be due to the blockage of the small windpipes leading to the air sacs mentioned above. This inflammation is called bronchiolitis or bronchiectasis — or bronchiolitis obliterans when these airways are blocked even more. Blockage can worsen symptoms of RA-ILD.
Scarring and fluid can also build up in the pleura (the covering around the lungs). Fluid in the pleura due to RA can prevent your lungs from expanding fully when you breathe in, leading to shortness of breath, fatigue, and pain when breathing.
RA-related scarring within the lungs can lead to nodules forming in the lungs. These nodules may look like lung cancer on scans like X-rays and CTs, but they do not lead to cancer. A ruptured nodule can sometimes cause a collapsed lung and cause more difficulties with breathing.
Pulmonary hypertension is high blood pressure specifically in the arteries carrying blood and oxygen between the lungs and the heart. Pleural disease, ILD, and airway blockage due to RA may cause the arteries to shrink or narrow and require the heart to work harder to move the blood. This shrinkage then leads to high blood pressure in those vessels and can eventually lead to heart failure if the underlying lung disease is not treated.
To diagnose RA-related lung disease, your doctor will usually order a scan of the lungs, such as an X-ray or high-resolution CT scan. You may also have to perform some breathing tests (called pulmonary function tests) to track your lung function.
Your doctor may also do a lung biopsy during the diagnostic period.
Most of the treatment and prevention of RA-related lung disease involves making sure that you are taking your medications for RA in general. In other words, many of the same antirheumatic drugs that are used in RA treatment also treat RA-related lung conditions.
Treatment may include the following:
Make sure to check in regularly with your doctor as recommended. The side effects of some treatments for RA, like methotrexate, can lead to lung complications, too. You may need to switch to a different medication if you notice lung symptoms.
If you have RA, take steps to protect your lungs. Consider quitting smoking if you currently smoke. Tobacco smoke can worsen RA’s effects on the human body, including the lungs, and is also a risk factor for diseases like COPD and lung cancer.
Also, make sure to get your recommended vaccines, especially the yearly flu shot and pneumonia vaccine, if your doctor recommends them. The flu or pneumonia can make lung symptoms worse, and immunosuppressant treatment for RA can make you more likely to get sick if you’re not vaccinated.
A new diagnosis or new symptoms of RA can be an added challenge in your life, and it may help to have the support of others who understand what you’re going through. On myRAteam, the social network for people with RA and their loved ones, more than 147,000 people come together to ask for advice and share their experiences living with RA.
Has rheumatoid arthritis affected your lungs? Share your story in the comments below or by starting a conversation on myRAteam.