Rheumatoid lung disease is a group of lung conditions that are associated with rheumatoid arthritis (RA).

Rheumatoid arthritis (RA) usually affects the joints, but it can also lead to scarring, inflammation, and nodules in the lungs. This can affect a person’s breathing.

This article looks at rheumatoid lung disease, why it happens, the types, symptoms, diagnosis, treatments, and outlook.

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Rheumatoid lung disease can develop as a complication of RA and a 2015 research article notes that lung problems are a major cause of illness and fatality in people with this disease.

The authors say this can happen because of:

  • persistent activation of the immune system
  • increased susceptibility to infections, which can stem from the use of medications that regulate the immune system
  • toxicity resulting directly from drugs that treat RA

RA is an autoimmune disease that affects the joints, but some people also develop inflammation and scarring in the lungs and other parts of the body.

Beyond the joints, the lungs are the most common site where people with RA develop inflammation. According to the Arthritis Foundation, about 10% of people with RA develop interstitial lung disease (ILD). ILDs are a group of diseases and the most common type of lung disease to occur with RA.

Rheumatoid lung disease can take various forms.

Types of rheumatic lung disease include:

ILDs are types of pulmonary parenchymal disease. This means they affect the area around the lungs’ air sacs. Vasculitis and pulmonary hypertension are vascular diseases. They involve the lungs’ blood vessels.

There may also be a higher risk of infection, which can increase the risk of lung damage.

People with RA have an eight times higher risk of developing lung disease than those without RA. Some people with RA may have specific factors that increase the risk of lung involvement.

A 2014 study looked at data for 230 people with a history of RA. Results showed that the most significant risk factor for developing rheumatoid lung disease was high levels of anti-CCP antibodies.

Anti-CCP antibodies are a type of protein that the immune system produces. Testing positive for anti-CCP antibodies is one indicator of RA. High levels may indicate the severity of the disease.

Other factors that may increase the risk are:

  • having active disease in the joints
  • being male
  • smoking, specifically in males
  • being older, as the average age at diagnosis is 64 years

People with RA may also have a higher risk of:

The symptoms of rheumatoid lung disease may vary, depending on the condition. Sometimes, respiratory symptoms appear before symptoms of RA affect the joints.

Rheumatoid lung diseases can involve:

  • inflammation of the pleura
  • scarring of the lungs
  • pleural effusion, a buildup of fluid between the chest wall and the lungs
  • nodules or small growths
  • airway damage, known as bronchiectasis, which can occur with RA-related lung disease
  • vasculitis
  • pulmonary hypertension, high blood pressure that affects the lungs

Lung nodules may not cause any symptoms, but scarring due to ILD can lead to shortness of breath and a dry cough.

Many of the symptoms of rheumatoid lung disease also occur with other respiratory conditions.

If a doctor suspects a person may have rheumatoid lung disease, they will:

  • take a medical history
  • do a physical exam
  • recommend some tests

Tests that can help diagnose rheumatoid lung disease include:

  • blood tests to measure markers of inflammation, such as sedimentation rate and C-reactive proteins
  • a high-resolution CT scan, which can reveal any scarring in the lungs
  • a lung function test, which measures how much air a person can blow out of their lungs, the volume of air in the lungs, and how much oxygen passes into the bloodstream
  • a lung biopsy, in some cases, to rule out cancer
  • bronchoscopy, to sample lung fluid for testing in a laboratory if a doctor suspects infection
  • thoracentesis, where a doctor takes a sample of pleural fluid for testing

Treatment for rheumatoid lung disease will depend on the person’s symptoms, the type of lung disease, and how the disease affects the body.

A person with small lung nodules and no symptoms may not need treatment.

Treatment cannot reverse any existing damage, but it can help slow the progression of RA-related lung disease and help manage symptoms.


In 2019, the Food and Drug Administration (FDA) approved nintedanib (Oftev) oral capsules to treat chronic, progressive ILDs that involve scarring. This means it is suitable for many people with rheumatoid lung diseases.

Clinical trials had shown that, in people with fibrosing (scarring) ILD who used nintedanib, the disease progressed more slowly than in those who took a placebo.

However, participants did not see any improvement in their quality of life.

Adverse effects of the drug included:

  • nausea
  • vomiting
  • diarrhea

Doctors sometimes prescribe corticosteroids to reduce inflammation. In 2015, however, researchers noted that it was unclear whether these medications were beneficial. They can also have adverse effects.

Other options

Other treatment options include:

  • oxygen therapy to improve a person’s quality of life
  • a lung transplant, in some cases
  • pulmonary rehabilitation, which teaches people about lung disease and tips for managing symptoms
  • aerobic exercise

Does medicare cover pulmonary rehab?

The outlook will depend on factors such as the severity and the type of disease a person has.

Scarring and ILD can significantly impact a person’s life expectancy, according to research from 2013. Data from 10 studies suggested that the median survival rate for people with ILD due to RA was 3.2–8.1 years after their diagnosis.

It is not possible to know exactly how RA-related lung disease will affect an individual. Lung problems can change over time, with symptoms becoming more severe and new complications developing.

Seeking help early may improve the prognosis. The outlook for a person with ILD is linked to how widespread the scarring is at the time of diagnosis.

It is not always possible to prevent rheumatoid lung disease, but the following approaches can help reduce the risk:

  • avoiding smoking
  • following a treatment plan for RA
  • attending regular checkups to monitor breathing and check for lung problems
  • following a doctor’s recommendations about the flu, COVID-19, and other vaccines
  • seeking medical advice at once if a cough or shortness of breath occur

Treatment might be more effective if a person has an early diagnosis.

People often ask the following questions about rheumatoid lung disease.

How long can you live with rheumatoid lung disease?

Factors affecting the outlook include the person’s age, the type of lung disease, and other factors. In 2013, one study concluded that the median survival rate for a person with ILD was 3.2–8.1 years, but it can vary.

What happens when RA attacks the lungs?

RA involves inflammation, and this can lead to scarring in the lungs, known as interstitial lung disease. Problems can also arise with the blood vessels, and a person may be more prone to infections.

RA usually affects the joints, but it can impact other body systems. A person with RA will have a higher risk of ILD and other lung diseases.

These diseases can lead to inflammation, nodules, scarring in the lungs, pleural effusion, and other airway issues.

Anyone with a diagnosis of RA should follow a doctor’s instructions regarding treatment and monitoring and seek medical advice if they develop a cough or breathing problems. Avoiding smoking may also help reduce the risk.

Treatment cannot reverse lung damage, but it may help slow the progression of lung disease.