Rheumatoid lung disease
Rheumatoid lung disease is a group of lung problems related to rheumatoid arthritis. The condition can include:
- Blockage of the small airways (bronchiolitis obliterans)
- Fluid in the chest (pleural effusions)
- High blood pressure in the lungs (pulmonary hypertension)
- Lumps in the lungs (nodules)
- Scarring (pulmonary fibrosis)
Lung disease - rheumatoid arthritis; Rheumatoid nodules; Rheumatoid lung
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
- Shortness of breath
- Joint pain, stiffness, swelling
- Skin nodules
Exams and Tests
The health care provider will perform a physical examination and ask about your symptoms.
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.
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
When to Contact a Medical Professional
Call your provider right away if you have rheumatoid arthritis and you develop unexplained breathing difficulties.
Corte TJ, Du Bois RM, Wells AU. Connective tissue diseases. In: Broaddus VC, Mason RJ, Ernst JD, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 6th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 65.
Lake F, Proudman S. Rheumatoid arthritis and lung disease: from mechanisms to a practical approach. Semin Respir Crit Care Med. 2014;35(2):222-238. PMID: 24668537 www.ncbi.nlm.nih.gov/pubmed/24668537.
Reviewed 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.