Rheumatoid lung disease

Lung problems are common in rheumatoid arthritis. They often cause no symptoms.

The cause of lung disease associated with rheumatoid arthritis is unknown. Sometimes, the medicines used to treat rheumatoid arthritis, especially methotrexate, may result in lung disease.

Symptoms may include any of the following:

• Chest pain
• Cough
• Fever
• Shortness of breath
• Joint pain, stiffness, and swelling
• Skin nodules

The health care provider will perform a physical examination and ask about your symptoms.

Symptoms depend on the type of lung disease rheumatoid arthritis is causing in the lungs.

The provider may hear crackles (rales) when listening to the lungs with a stethoscope. Or, there may be decreased breath sounds, wheezing, a rubbing sound, or normal breath sounds. When listening to the heart, there may be abnormal heart sounds.

The following tests may show signs of rheumatoid lung disease:

• Chest x-ray
• CT scan of the chest
• Echocardiogram (may show pulmonary hypertension)
• Lung biopsy (bronchoscopic, video-assisted, or open)
• Lung function tests
• Needle inserted into the fluid around the lung (thoracentesis)
• Blood tests for rheumatoid arthritis
  

Many people with this condition have no symptoms. Treatment is aimed at the health problems causing the lung problem and the complications caused by the disorder. Corticosteroids or other medicines that suppress the immune system are sometimes useful.

There is no evidence that pirfenidone or nintedanib work for people with rheumatoid lung disease and fibrosis (like they do for the idiopathic form of the disease).

Outcome is related to the underlying disorder and the type and severity of lung disease. In severe cases, lung transplantation can be considered. This is more common in cases of bronchiolitis obliterans, pulmonary fibrosis, or pulmonary hypertension.

Rheumatoid lung disease may lead to:

• Collapsed lung (pneumothorax)
• Pulmonary hypertension

Call your provider right away if you have rheumatoid arthritis and you develop unexplained breathing difficulties.

Lung disease - rheumatoid arthritis; Rheumatoid nodules; Rheumatoid lung

• Interstitial lung disease - adults - discharge

Corte TJ, Wells AU. Connective tissue diseases. In: Broaddus VC, Ernst JD, King TE, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 7th ed. Philadelphia, PA: Elsevier; 2022:chap 92.

Yunt ZX, Solomon JJ. Lung disease in rheumatoid arthritis. Rheum Dis Clin North Am. 2015;41(2):225-236. PMID: PMC4415514 www.ncbi.nlm.nih.gov/pmc/articles/PMC4415514/.

Updated by: Denis Hadjiliadis, MD, MHS, Paul F. Harron, Jr. Associate Professor of Medicine, Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.