What You Need to Know About RA and Lung Disease
By Linda Rath
Learn more about how respiratory problems are one of the most serious and common complications of rheumatoid arthritis.
Interstitial Lung Disease
What Is Interstitial Lung Disease?
Risk Factors for Interstitial Lung Disease
Smoking: People with RA who smoke are more likely to develop ILD.
Higher RA disease activity: High levels of rheumatoid factor (RF) and anti-cyclic citrullinated peptides (anti-CCP) antibodies – substances that are indicative of more active disease – increase the risk for development of ILD.
Older age at diagnosis: People who are diagnosed with rheumatoid arthritis after age 60 are more likely to develop ILD.
Male Gender: Men with RA have a two-to-three times higher risk of developing ILD than women.
Treatment with methotrexate and other DMARDs: Several DMARDs, including methotrexate, leflunomide and azathioprine, as well as biologics, particularly tumor necrosis factor (TNF) inhibitors, have been associated with RA-ILD. However, Dr. Teng Moua, a pulmonologist specializing in ILD at the Mayo Clinic in Rochester, Minn., says the risk of methotrexate-induced lung injury is less than 1 percent and is reversible once the drug is stopped. While for many, the benefits of methotrexate far outweigh its risks, it is not recommended for people with existing ILD or RA-ILD by the American College of Rheumatology guidelines.
Diagnosis of Interstitial Lung Disease
The diagnostic process includes a comprehensive clinical exam, X-rays and lung function tests. If there are risk factors for ILD or abnormal X-ray findings, your doctor will likely perform a high resolution CT.
Treatment of Interstitial Lung Disease
- Corticosteroids and immunosuppressants: These treatments may not work the same way for everyone, and patients may experience medication side effects.
- Oxygen therapy: This may be prescribed along with building aerobic fitness to help improve quality of life.
- Lung Transplant: In some cases, a lung transplant is an effective and necessary option to regain lung function.
- Treat underlying RA: The best approach is to treat the underlying RA and resulting inflammation, although ILD may get worse despite well-controlled arthritis.
How Can You Protect Your Lungs?
- Don’t smoke.
- Get flu and pneumonia vaccines (but always check with your doctor before getting any vaccinations). If you’re taking immunosuppressant medications for your RA, you may be at a higher risk for illnesses like the flu and pneumonia, which may cause further lung-related complications.
- Have regular check-ups, so your doctor can monitor your lungs regularly.
- Tell your doctor if you have shortness of breath or dry cough right away.
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