Lung-related conditions and symptoms associated with rheumatoid arthritis (RA) include 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.

Rheumatoid arthritis-associated interstitial lung disease (RA-ILD) can develop due to the immune system attacking the lungs. RA-ILD occurs in 5% to 10% of people with RA.

Your lungs may already have a significant amount of inflammation by the time you start experiencing symptoms. This can make it difficult to detect early. However, the earlier you get diagnosed, the sooner you can start treatment to prevent disease progression and scarring.

To reach a diagnosis, you may first undergo X-rays and lung function tests. If the results of these tests are abnormal, your doctor may order a high-resolution CT.

Treating RA-ILD may include:

  • corticosteroids and immunosuppressants
  • oxygen therapy
  • treating underlying RA

A lung transplant may be recommended as a last resort for more severe cases.

You may be able to reduce your risk of lung-related complications by taking steps such as:

  • quitting smoking
  • administration of vaccines to protect against lung infections such as pneumonia and the flu
  • visiting your doctor for regular check-ups
  • notifying your doctor of shortness of breath or coughing as soon as possible

Pulmonary fibrosis can occur in some people with RA. It is a progressive disease that gets worse over time. There is no cure at the moment.

Some symptoms of pulmonary fibrosis include:

  • shortness of breath, particularly during exercise
  • shallow breathing
  • a chronic dry, hacking cough
  • weakness and fatigue
  • unintentional weight loss
  • clubbing, or widening and rounding, of the tips of your fingers and toes

Treatment for pulmonary fibrosis may include medications such as antifibrotic drugs. In some cases, oxygen therapy may be needed.

In the most severe cases, a lung transplant may be necessary.

Lung nodules that develop from RA, called pulmonary rheumatoid nodules, are somewhat uncommon. Men are up to seven times more likely to develop lung nodules than women.

Nodule growth can also be accelerated by methotrexate, which is a medication used to treat RA.

Lung nodules don’t typically have any noticeable symptoms, but they may present with a cough or coughing up blood, especially if the nodules cavitate.

B-cell-targeted therapies such as rituximab (Rituxan) may help shrink the nodules and reduce their number. Your doctor may also prescribe RA medications that do not damage your lung tissue as an alternative to methotrexate.

Up to 50% of rheumatoid nodules may lead to complications, such as pleural effusion or pneumothorax. In these cases, these nodules may need to be removed surgically.

Pleural effusion is a complication of RA that occurs when fluid builds up between the chest wall and the lining around the lung tissue.

Treatment can include:

  • antibiotics
  • antifungals
  • antiparasitic medicines

Left untreated, pleural effusion can lead to complications such as sepsis and shock.

Small airway obstruction has been reported to occur in 8% to 65% of individuals with RA.

Symptoms of small airway obstruction can include:

  • wet or dry cough
  • shortness of breath
  • fatigue

While RA treatments may be able to prevent a small airway obstruction from progressing, 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:

RA may lead to complications involving your lungs, such as RA-ILD, pulmonary fibrosis, pleural effusions, lung nodules, and small airway obstructions.

The risk of developing some of these complications may increase due to certain factors, including if you are male or smoke.

It is important to inform your doctor if you start to experience new symptoms related to your lungs. Early diagnosis may lead to better outcomes.