Watching for Lung Issues
Without fail at every appointment with my rheumatologist, he asks if I have been coughing and listens to my lungs.
Every couple of years, he orders chest x-rays to make sure they are clear and nothing has been missed.
It’s all a part of being vigilant about interstitial lung disease.
RA inflammation affects more than joints
Unfortunately, rheumatoid arthritis (RA) doesn’t stop at attacking the joints.
In my case, I’ve developed some psoriasis and had some early gum disease (gingivitis), that both thankfully have responded to early treatment.
It’s not always easy, but it’s important to sometimes use a wide lens on our illness. By this I mean to be aware of other inflammation-related illnesses that can come with the RA and cause serious health concerns.
How common is interstitial lung disease?
Although it is relatively rare, interstitial lung disease is one type of lung disease that can be experienced by people with RA.
Rare, but serious
Despite that about 6 percent of patients experience this condition, it is important to be aware of IL because it can be serious and even deadly.
IL refers to a group of lung illnesses involving the air sacs. For RA patients, IL frequently involves pneumonia and bronchiolitis (inflammation and congestion of the small airways).
A study on mortality rate of RA-related interstitial lung disease
A recent study examined the mortality rate of RA-related interstitial lung disease from 2005-2018 of 47 patients.1
Compared to the general population, the mortality rate was significantly higher for these patients and correlated to exacerbated IL disease and pneumonia.
Additionally, a specific type of pneumonia (usual interstitial pneumonia) was most correlated with IL and higher mortality rates.1,2
These results confirmed earlier research that found patterns of usual interstitial pneumonia on a high-resolution CT scan predict worse survival rates for RA patients with interstitial lung disease. The authors recommended patients with IL have scans to identify this risk in the hope of treatment.2
Can RA treatments contribute to lung issues?
Unfortunately, some of the RA medications can also contribute to lung issues.
While I was taking methotrexate, I needed regular scans to make sure my lungs stayed healthy. If any signs had appeared, my medication would have been immediately discontinued.
This is similar to some of the medications that can cause eye damage (which can also be caused by the RA itself).
RA weaves a tangled web of inflammation, potential complications, and side conditions. With something like IL, awareness and vigilance are crucial.
Awareness, prevention, and treatment
Patients need to know that these types of diseases are possible and be aware of how they are feeling so they can raise concerns with their physician.
At the same time, we need our doctors to be checking us for changes in the lungs, breathing, and the periodic scan to ensure we are keeping our lungs healthy or getting issues addressed quickly.
Unfortunately, interstitial lung disease is difficult to treat and complicated by the treatments RA patients commonly take. A research review of treatments highlighted the issues and suggests a future role for antifibrotic medications.3
What is recovery like?
A few years ago, I had a bout of mystery bronchitis and pneumonia. We never knew where it came from or how it started, so it was surprising.
At first, I felt okay and tried to continue on with daily life. But then the illness hit me and I just had to stop and drop everything to rest and recover. I became so tired of being tired!
However, it was the right thing to do because I was able to recover without any long-term effects.
While it’s true that anyone can get sick or develop a lung disease, the risks are raised for RA patients. We contend with inflammation-related and exacerbated diseases. We get sick easier and have more difficulty recovering.
All of this means, we have to be more watchful of health problems (especially serious ones like interstitial lung disease) and quick to act if we have any unusual symptoms.
You know you have RA when [select all that apply in your experience]: