Rheumatoid lung disease
Lung disease - rheumatoid arthritis; Rheumatoid nodules; Rheumatoid lungRheumatoid lung disease is a group of lung problems related to rheumatoid arthritis (RA). The condition can include:
Rheumatoid arthritis
Rheumatoid arthritis (RA) is a disease that leads to inflammation of the joints and surrounding tissues. It is a long-term disease. It can also aff...
- Blockage of the small airways (bronchiolitis obliterans)
- Fluid in the chest (pleural effusions)
Pleural effusions
A pleural effusion is a buildup of fluid between the layers of tissue that line the lungs and chest cavity.
ImageRead Article Now Book Mark Article - High blood pressure in the lungs (pulmonary hypertension)
Pulmonary hypertension
Pulmonary hypertension is high blood pressure in the pulmonary arteries of the lungs. It makes the right side of the heart work harder than normal....
ImageRead Article Now Book Mark Article - Lumps in the lungs (nodules)
- Scarring (pulmonary fibrosis)
Pulmonary fibrosis
Interstitial lung disease (ILD) is a group of lung disorders in which the lung tissues become inflamed and then damaged.
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Causes
Lung problems are common in people with RA. They often cause no symptoms, but for some people they are the main symptom of their RA.
The cause of lung disease associated with RA is unknown. Sometimes, the medicines used to treat RA, especially methotrexate, may result in lung disease.
Symptoms
Symptoms may include any of the following:
- Chest pain
- Cough
Cough
Coughing is an important way to keep your throat and airways clear. But too much coughing may mean you have a disease or disorder. Some coughs are d...
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- Shortness of breath
Shortness of breath
Breathing difficulty may involve:Difficult breathing Uncomfortable breathingFeeling like you are not getting enough air
ImageRead Article Now Book Mark Article - Joint pain, stiffness, and swelling
- Skin nodules
Skin nodules
Skin nodules are solid or cystic raised bumps in the skin that are wider than 0. 39 inches (in) or 1 centimeter (cm), but less than 0. 79 in (2 cm). ...
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Exams and Tests
Your health care provider will perform a physical exam and ask about your symptoms.
Symptoms depend on the type of lung disease RA is causing in the lungs.
When listening to the lungs with a stethoscope, your provider may hear normal breath sounds or:
- Crackles (rales)
- Decreased breath sounds
- Wheezing
Wheezing
Wheezing is a high-pitched whistling sound during breathing. It occurs when air moves through narrowed breathing tubes in the lungs.
ImageRead Article Now Book Mark Article - A rubbing sound
When listening to the heart, there may be abnormal heart sounds.
The following tests may show signs of rheumatoid lung disease:
- Chest x-ray
Chest x-ray
A chest x-ray is an x-ray of the chest, lungs, heart, large arteries, ribs, and diaphragm.
ImageRead Article Now Book Mark Article - CT scan of the chest
CT scan of the chest
A chest CT (computed tomography) scan is an imaging method that uses x-rays to create cross-sectional pictures of the chest and upper abdomen....
ImageRead Article Now Book Mark Article - Echocardiogram (may show pulmonary hypertension)
Echocardiogram
An echocardiogram is a test that uses sound waves to create pictures of the heart. The picture and information it produces is more detailed than a s...
ImageRead Article Now Book Mark Article - Lung biopsy (bronchoscopic, video-assisted, or open)
Open
An open lung biopsy is surgery to remove a small piece of tissue from the lung. The sample is then examined for cancer, infection, or lung disease....
ImageRead Article Now Book Mark Article - Lung function tests
Lung function tests
Pulmonary function tests are a group of tests that measure breathing and how well the lungs are functioning.
ImageRead Article Now Book Mark Article - Needle inserted into the fluid around the lung (thoracentesis)
Thoracentesis
Thoracentesis is a procedure to remove fluid from the space between the lining of the outside of the lungs (pleura) and the wall of the chest....
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Blood tests for rheumatoid arthritis
Rheumatoid factor (RF) is a blood test that measures the amount of the RF antibody in the blood.
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Treatment
Many people with this condition have no symptoms. Treatment is usually aimed at the RA 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 emerging evidence that pirfenidone and nintedanib may work for people with fibrosis due to rheumatoid lung disease.
Outlook (Prognosis)
The 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.
Possible Complications
Rheumatoid lung disease may lead to:
-
Collapsed lung (pneumothorax)
Pneumothorax
A collapsed lung occurs when air escapes from the lung. The air then can fill the space outside of the lung between the lung and chest wall. This b...
ImageRead Article Now Book Mark Article - Pulmonary hypertension
When to Contact a Medical Professional
Contact your provider right away if you have rheumatoid arthritis and you develop unexplained breathing difficulties or worsening of baseline breathing difficulties.
References
Corte TJ, Wells AU. Connective tissue diseases. In: Broaddus VC, Ernst JD, King TE, et al, eds. Murray & Nadel's Textbook of Respiratory Medicine. 7th ed. Philadelphia, PA: Elsevier; 2022:chap 92.
Johnson SR, Bernstein EJ, Bolster MB, et al. 2023 American College of Rheumatology (ACR)/American College of Chest Physicians (CHEST) guideline for the treatment of interstitial lung disease in people with systemic autoimmune rheumatic diseases. Arthritis Care Res (Hoboken). 2024;76(8):1051-1069. PMID: 38973731 pubmed.ncbi.nlm.nih.gov/38973731/.
Raghu G, Martinez FJ. Interstitial lung disease. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 80.
Bronchoscopy - illustration
Bronchoscopy is a surgical technique for viewing the interior of the airways. Using sophisticated flexible fiber optic instruments, surgeons are able to explore the trachea, main stem bronchi, and some of the small bronchi. In children, this procedure may be used to remove foreign objects that have been inhaled. In adults, the procedure is most often used to take samples of (biopsy) suspicious lesions and for culturing specific areas in the lung.
Bronchoscopy
illustration
Respiratory system - illustration
Air is breathed in through the nasal passageways, travels through the trachea and bronchi to the lungs.
Respiratory system
illustration
Bronchoscopy - illustration
Bronchoscopy is a surgical technique for viewing the interior of the airways. Using sophisticated flexible fiber optic instruments, surgeons are able to explore the trachea, main stem bronchi, and some of the small bronchi. In children, this procedure may be used to remove foreign objects that have been inhaled. In adults, the procedure is most often used to take samples of (biopsy) suspicious lesions and for culturing specific areas in the lung.
Bronchoscopy
illustration
Respiratory system - illustration
Air is breathed in through the nasal passageways, travels through the trachea and bronchi to the lungs.
Respiratory system
illustration
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Review Date: 4/10/2025
Reviewed By: Allen J. Blaivas, DO, Division of Pulmonary, Critical Care, and Sleep Medicine, VA New Jersey Health Care System, Clinical Assistant Professor, Rutgers New Jersey Medical School, East Orange, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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