If you have had RA for any length of time and did research on it online, you have undoubtedly seen a link for the term RA Lung. I know I have seen it many times, and breezed right past it. I believe I had clicked on it once as I know it refers to RA affecting the lungs, and is not extremely uncommon. That was about the depth of my knowledge on this issue though. That all changed over the last couple of weeks.
I had my routine Chest Xray a few weeks ago, if you have RA and are on treatment for it you really should have one at least yearly to keep abreast of any sort of side effects, infections, etc. I had my appt with my Rheumy, stopped at the lab to have blood drawn, zipped down the hallway to the infusion suite to get my Orencia infusion and on the way out of RA wonderland stopped for my chest xray. This was on a Tuesday, on Wednesday my Rheumy called me personally to inform me that I had “Shadows” in my lungs on the xray and I needed to get a CT scan asap to ascertain what was going on. NOT the kind of phone call you want to get, I was worried, my wife was a train wreck, my CT scan was scheduled for Thursday and it seemed like a year away instead of the next day.
Thursday I got the CT scan, all 5 minutes of it, and settled in to wait a week for results. The diagnostic lab said it would take 24-48 hours to read the results and notify my doctor. THANKFULLY my Rheumy called me at home again Friday morning to report I DO NOT have lung cancer. He said I had RA Lung and we would discuss it at an appt he was setting up for me. You can imagine it felt like the weight of the world fell off my and my wife’s shoulders, but I was still somewhat worried. My doctor had said NOT to worry, but that is much easier said than done.
I dug into the internet, investigating RA Lung much as I had RA when I was first diagnosed, tons of open windows, notes all over my desk, bookmarks flung about all willy nilly. What I found did put me much more at rest. RA Lung is not uncommon, though it does not show up very well in Xrays. Roughly one percent of RA patients show signs of pulmonary rheumatoid nodules in conventional X-rays, according to the Johns Hopkins Arthritis Center. However, high resolution computed tomography (CT) scans reveal signs of nodules in roughly 22 to 28 percent of patients. And an article I found published by the AF found that if all patients with connective tissue disorders had a chest CT scan, probably more than half would show interstitial lung issues. Somehow, knowing I was not alone made me feel better about it. Of course the type of lung disease and severity, much like RA can vary widely.
I had my follow up visit with my Rheumy. He informed me that the nodules in my lungs, are much like the ones on my forearms. They show no signs of being cancerous, and are more than likely caused by inflammation. I will need a follow up CT scan every 6 months to follow them, making sure they are not growing, causing further inflammation or stiffening the lungs themselves. I have one in the midline of my right lung and one in the lower lobe of my left lung. Although they are benign, that does not mean that they cannot cause problems on their own. Here is a list from the Mayo Clinic of the common problems associated with RA Lung.
- Painful breathing. Rheumatoid arthritis can cause inflammation of the lining of the lungs (pleurisy). The inflammation can cause sharp pain while breathing.
- Shortness of breath. Fluid due to inflammation of the lining of the lungs may accumulate around the lungs (pleural effusion). This accumulation can cause shortness of breath.
- Lung nodules. Small lumps may form in the lungs (rheumatoid nodules), as well as in other parts of the body. Lung nodules usually cause no signs or symptoms, and they don’t pose a risk of lung cancer. In some cases, however, a nodule can rupture and cause a collapsed lung.
- Scarring of the lungs. Rheumatoid arthritis can lead to scarring within the lungs. Signs and symptoms may include shortness of breath, chronic dry cough, fatigue, weakness and loss of appetite.
The one thing I found across the many sites I read suggested one thing over and over. If you have any sort of shortness of breath beyond anything normal for you (I have Asthma severe enough to be considered COPD) inform your Rheumy right away. Smoking, now or in the past is a big consideration in your likelihood to get RA Lung, so if you do smoke, here is yet another great reason to kick the habit! I quit 20 yrs ago myself.
All in all, I am much more at ease with this new twist to the RA puzzle, just another symptom to manage and keep an eye on. I would stress to all of you that if you do not get a yearly chest xray, ask for one! A baseline xray is a great thing to have in case of future issues.