Breathing problems probably aren’t the first (or even third) thing you associate with rheumatoid arthritis. But because RA is a systemic autoimmune disease, it can affect other parts of the body, including the lungs. In fact, as much as two-thirds of people living with the condition may develop lung disease, and sometimes it can be life-threatening. This, among other issues, is why some doctors say a diagnosis of RA is a medical emergency.
We know reading about this can feel scary, but remember, the more you know, the better you can protect yourself. Plus, there’s a lot you can do to help keep your lungs as healthy as possible.
What Is Interstitial Lung Disease (ILD)?
When RA inflammation affects the lungs, it can leave the tissue scarred. It’s this resulting damage (also called fibrosis) that contributes to a group of conditions known as interstitial lung disease (ILD). As scarring progresses, the lung tissue continues to stiffen, making breathing difficult. Someone with severe ILD might need oxygen therapy, or even a lung transplant. But it doesn’t always get that serious. Here are some things to look for when it comes to tracking ILD and getting treatment.
The most common time in life to get ILD is between 50 to 60 years of age, and the following factors may increase your risk:
- Being a man
- Long-standing RA (more than 10 years)
- Higher disease activity
- Certain RA medications, including a class of biologics known as tumor necrosis factor (TNF) inhibitors
How Is ILD Diagnosed?
There are a few symptoms to take note of when it comes to diagnosing ILD, according to Alireza Meysami, M.D., interim division head of rheumatology at Henry Ford Health System and clinical associate professor of medicine at Wayne State University in Detroit. Dr. Meysami says he instructs his team to always check patients for coughs or a crackle in the lungs. They also look for clubbing of the nails — when nails look curved like the back of a spoon — which indicates that low blood oxygen is affecting the tissue around the nailbed.
“If these symptoms are there or there’s even a little bit of suspicion, I immediately get a pulmonary-function test and high-resolution CT scan with immediate referral to a pulmonologist,” he says. Usually, imaging tests can confirm the diagnosis, but if the doctors cannot make a clinical judgement from the scans, they may do a lung biopsy as a last resort.
What Is the Treatment for ILD?
Treatment of ILD depends on the type and what the likely cause is, says Dr. Meysami. For instance, rheumatologists will determine whether there’s any correlation between medication and lung disease. In cases where a patient has just started taking a TNF inhibitor and develops symptoms, the doctor would conclude they are caused by the drug. “We’d stop that medication with the expectation of the resolution of the symptoms,” Dr. Meysami says.
RA-associated ILD requires aggressive treatment, often with a biologic called rituximab, to get the high levels of inflammation under control, says Dr. Meysami. This type of ILD can be difficult to manage.
How to Reduce Your Risk for ILD
- Quit smoking. That’s really the end of that story. If you need help getting smoke-free, check out these resources from the Centers for Disease Control and Prevention. And talk to your doctor.
- “Avoid any environmental or occupational exposure,” Dr. Meysami recommends. That is, if you work in an area with a lot of secondhand smoke, in a coal mine, or are exposed to asbestos, finding another job, if at all possible, may protect your health.
- “Get a baseline chest X-ray before starting treatment or at the beginning of rheumatoid arthritis,” Dr. Meysami says. This will help your doctors to identify potential changes.
- Treat your RA aggressively to help protect your lungs. “Active disease results in more systemic involvement,” Dr. Meysami says.
- Act fast if you have symptoms like an unexplained dry cough, shortness of breath, fatigue, weight loss, and/or clubbing of your fingernails. Any of these warrant an immediate call your rheumatologist. Your general practitioner may not know right away to connect RA with pulmonary disease. “We don’t want to sit on ILD,” Dr. Meysami says. If you have ILD, getting prompt treatment can help prevent the scarring that can obstruct breathing.
It is never easy to learn about the potential for very serious complications of RA. Worry and dread can become overwhelming. It’s important to balance paying attention to your body with a focus on living your life. Make sure you have a conversation with your doctor about how best to manage your risks without letting symptom-monitoring take over your life. Reaching out to your RA community on social media, or in real life, can help you feel understood and supported along the way.