Rheumatoid Arthritis and Lung Problems

Updated by Linda Rath | April 18, 2023

Short of breath or have a cough that won’t quit? It could be COVID-19 or a nasty cold or flu virus. Or the problem could be related to your rheumatoid arthritis (RA). Although RA attacks the joints, it can also affect other organs, including the lungs. As many as 10% to 30% of people with RA will eventually develop RA-related lung disease, often men their 50s and 60s who are current or former smokers. In a few people, lung problems may appear before joint symptoms do.

Types of RA-Associated Lung Disease

RA can cause several types of lung problems, including:

• Interstitial lung disease (ILD). This large group of disorders is marked by irreversible scarring from long-term inflammation. It’s the most common type of RA-associated lung disease and few treatments are available that effectively slow its progression. ILD is serious, and some forms can be fatal.
• Airway obstruction. The walls of the lungs’ small airways thicken due to chronic inflammation, infection or injury, which causes mucus buildup, chronic cough, weakness and fatigue. 
• Lung nodules. Often called rheumatoid nodules, these benign lumps rarely cause symptoms but occasionally can rupture. Long-term treatment with methotrexate and other conventional disease-modifying antirheumatic drugs (DMARDs) has been implicated in some cases.
• Pleural disease. The pleura – the tissue around the lungs – can become inflamed and filled with fluid. The fluid may go away on its own; if not, it can cause difficult and painful breathing.

Much more rarely, RA can attack joints in the larynx, or voice box, leading to hoarseness, pain during swallowing or talking and a feeling of something stuck in the throat. 

Medications and Lung Disease

The link between RA medications and lung disease isn’t clear. At one time, it was thought that some of the most common arthritis drugs, including methotrexate and certain tumor necrosis factor (TNF) blockers, increased lung disease risk or made existing symptoms worse. Newer research is more mixed. Some studies report that methotrexate and certain other arthritis drugs don’t make lung disease more likely and may even be helpful, while others suggest the opposite. Almost all research, however, supports the effectiveness of the non-TNF biologic abatacept (Orencia) in slowing or even improving ILD.

Getting a Diagnosis

See your doctor if you have a chronic cough or other respiratory symptoms that don’t get better in a week or two and you test negative for COVID-19. As a starting point, you may have a physical exam, lung function test and chest X-ray. If your symptoms suggest ILD, the gold standard test for RA patients is a high-resolution CT scan.