What Is Rheumatoid Lung Disease?

Lung Abnormalities Can Occur With Rheumatoid Arthritis

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Rheumatoid lung disease, as its name suggests, is associated with rheumatoid arthritis. Of the 1.5 million Americans who have rheumatoid arthritis, nearly half have some abnormal lung function. Up to one-fourth may develop rheumatoid lung disease.

Symptoms of Rheumatoid Lung Disease

Symptoms associated with rheumatoid lung disease, which occur in addition to typical arthritic symptoms of joint pain, joint swelling, joint stiffness, and nodules, include:

  • shortness of breath
  • cough
  • chest pain
  • fever
  • crackle sounds when listening to lungs with stethoscope (decreased breath sounds or normal breath sounds are also possible)

Diagnosis and Treatment of Rheumatoid Lung Disease

Procedures used to help diagnose rheumatoid lung disease include:

  • chest x-rays
  • computed tomography (CT) scan of the chest
  • echocardiogram
  • thoracentesis
  • bronchoscopy

In rheumatoid lung disease, the air sacs or alveoli of the lungs and their supporting structures become scarred by inflammation, resulting in impaired lung function. Currently, there are no proven treatments for rheumatoid lung disease, but corticosteroids and immunosuppressants are often recommended.

Thoracic and Pulmonary Abnormalities Associated With Rheumatoid Lung Disease

The thoracic and pulmonary abnormalities associated with rheumatoid lung disease include:

Interstitial Lung Disease and Rheumatoid Arthritis

The most common manifestation of pulmonary disease in rheumatoid arthritis is interstitial lung disease. Patients with severe rheumatoid arthritis are more likely to develop rheumatoid arthritis-associated interstitial lung disease.

A thorough report by Dr. Jeffrey T. Chapman from the Cleveland Clinic Foundation details the prevalence, signs and symptoms, diagnosis, and treatment for interstitial lung disease.

Findings reported in Arthritis & Rheumatism (January 2005), authored by Mayo Clinic researchers, suggested that rheumatoid lung disease may be fundamentally different from other forms of lung disease and possibly should be treated differently. Advancements in computer-assisted image analysis have made it possible to diagnose rheumatoid lung disease earlier and treat it aggressively as a disease of the immune system. Also, the Mayo Clinic research revealed an abundance of a type of T cell, known as a CD4 T cell, in rheumatoid lung disease tissue samples. 

The most frequent forms of interstitial lung disease are usual interstitial pneumonia and nonspecific interstitial pneumonia. Another presentation combines pulmonary fibrosis and emphysema.

Smoking, a known risk factor of rheumatoid arthritis, may also play a role in rheumatoid arthritis-associated interstitial lung disease, along with genetic and immunologic mechanisms.

It also has been suggested that rheumatoid arthritis medications may possibly lead to drug-induced interstitial lung disease, in some cases.

Rheumatoid Arthritis Treatments and Lung Disease

Methotrexate is the gold standard treatment for rheumatoid arthritis. But, methotrexate has also been suggested as a causative agent in interstitial lung disease. Researchers evaluated the the relative risk of pulmonary disease among rheumatoid arthritis patients who were treated with methotrexate. Results, published in Arthritis & Rheumatology (2014), concluded there is a small but significant increase in the risk of lung disease in rheumatoid arthritis patients treated with methotrexate compared with other disease-modifying anti-rheumatic drugs (DMARDs) and biologic drugs.

In January 2016, study results were published in the Journal of Rheumatology that evaluated the relative risk of pulmonary disease among rheumatoid arthritis patients treated with Arava (leflunomide). No evidence of increased respiratory adverse events was found in randomized, controlled trials of rheumatoid arthritis patients treated with leflunomide.


Methotrexate and lung disease in rheumatoid arthritis: a meta-analysis of randomized controlled trials. Conway R. et al. Arthritis & Rheumatology. 2014 Apr;66(4):803-12.

Leflunomide Use and Risk of Lung Disease in Rheumatoid Arthritis: A Systematic Literature Review and Metaanalysis of Randomized Controlled Trials. Conway R. et al. Journal of Rheumatology. March 15, 2016. Epub ahead of print.

Interstitial lung disease in rheumatoid arthritis. Revue Medicale Suisse. 2011 Nov 23;7(318):2272-7. Froidevaux-Janin S. et al.

Increased CD4+ T cell infiltrates in rheumatoid arthritis–associated interstitial pneumonitis compared with idiopathic interstitial pneumonitis. Arthritis & Rheumatism. January 2005. 52(1):73–79. Turesson C. et al.

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