What are the other Names for this Condition? (Also known as/Symptoms)

• Rheumatoid Arthritis affecting Lungs
• Rheumatoid Nodules of Lungs

What is Rheumatoid Lung Disease? (Condition/Background Information)

• Rheumatoid Lung Disease is a collection of various health conditions that occurs due to underlying rheumatoid arthritis (RA)
• Rheumatoid Lung Disease can cause damage to the lungs in several ways including:
  • Affecting the pleura causing pleural inflammation and pleural effusion
  • Affecting the lung parenchyma causing rheumatoid nodules in the lungs with breathing issues
  • It can obstruct the airways and cause obstructive bronchitis
• All these effects on the lungs can result in reduced oxygen delivery to the body. Sometimes, the medications given to treat RA can also cause side effects in the lungs and are included in Rheumatoid Lung Disease
• The presence of fibrosis within the lungs can result in lung fibrosis, which can cause significant health issues
• In majority of cases, the findings of Rheumatoid Lung Disease are minor and they do not cause significant signs and symptoms. However, in some individuals, the Rheumatoid Lung Disease can progress in severity affecting the lung function
• Both men and women may be affected, but men are more susceptible to Rheumatoid Lung Disease than women. Individuals who have prior lung damage are affected by the condition more severely
• The most common signs and symptoms of Rheumatoid Lung Disease include difficulty in breathing and chest pain. The diagnosis of the condition is made through a physical exam and medical history, blood tests, chest x-rays, pulmonary function tests, and lung biopsies
• The treatment options for Rheumatoid Lung Disease include treatment of the underlying rheumatoid arthritis, medications to improve lung function, and removal of fluid from the pleural cavity (pleural effusion)
• The prognosis of Rheumatoid Lung Disease depends upon the severity and extent of lung damage

Who gets Rheumatoid Lung Disease? (Age and Sex Distribution)

• Rheumatoid Lung Disease is more commonly seen in men than women. The reason for this is unknown
• Individuals with severe rheumatoid arthritis develop more severe lung disease. Approximately 50% of the individuals with RA, can develop Rheumatoid Lung Disease
• This condition is seen worldwide; all racial and ethnic groups are affected

What are the Risk Factors for Rheumatoid Lung Disease? (Predisposing Factors)

The following are the risk factors for developing Rheumatoid Lung Disease:

• Being a male has an increased risk
• Having a prior lung disease, such as pulmonary fibrosis, asthma, and prior lung infection, can increase the chances of Rheumatoid Lung Disease
• Individuals with rheumatoid arthritis having more severe signs and symptoms are more likely to get Rheumatoid Lung Disease

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Rheumatoid Lung Disease? (Etiology)

• The cause of Rheumatoid Lung Disease is unknown in most cases
• Some researchers believe that it is due to immune dysfunction
• Some medications used to treat rheumatoid arthritis can also result in Rheumatoid Lung Disease (medication side effects)

What are the Signs and Symptoms of Rheumatoid Lung Disease?

Many individuals with Rheumatoid Lung Disease do not present any signs and symptoms. In individuals who have significant lung damage, the following may be noted:

• Severe chest pain due to pleural damage
• Persistent cough
• Fibrosis of lungs causing difficulty in breathing
• Signs and symptoms associated with underlying rheumatoid arthritis, such as severe joint pain

How is Rheumatoid Lung Disease Diagnosed?

The diagnosis of Rheumatoid Lung Disease may involve the following steps:

• Complete physical examination with medical history evaluation (including history of rheumatoid arthritis)
• A variety of blood tests to detect the severity of RA can be helpful in assessing the extent of lung damage
• Presence of fibrosis on a chest x-ray or a CT scan of the lungs
• Pulmonary function tests can help determine the extent of lung damage and help the healthcare provider to assess the ability of lungs, to deliver oxygen to the body
• Needle biopsy of lung: A needle biopsy may not be helpful, because one may not be able to visualize the different morphological areas of the tumor. Hence, a needle biopsy as a diagnostic tool has certain limitations, and an open surgical biopsy is preferred
• Open lung biopsy: A tissue biopsy is performed and sent to a laboratory for a pathological examination, who examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Rheumatoid Lung Disease?

The possible complication associated with Rheumatoid Lung Disease includes:

• Irreversible lung damage such as lung fibrosis
• Development of pneumothorax (collapsed lung)
• Development of pulmonary hypertension, which is indicated by an increased pressure in the arteries of the pulmonary blood vessel system
• Abnormal dilatation of the airways leading to bronchiectasis; this results from abnormal scarring of the airways caused by severe inflammation
• Individuals with severe underlying rheumatoid arthritis have a 75% chance of developing lung fibrosis with scarring of lung tissue

How is Rheumatoid Lung Disease Treated?

In a majority of the individuals, Rheumatoid Lung Disease may remain asymptomatic, and hence, no treatment may be required. In symptomatic individuals, the following treatment measures may be considered:

• Treating underlying rheumatoid arthritis
• Changing medication for underlying RA, which is causing lung damage
• Immunosuppressive therapy using corticosteroids
• In severe cases of Rheumatoid Lung Disease, lung transplantation may be necessary. It is important to note that in individuals with a transplanted lung, the fibrosis can sometimes recur in the transplanted lung

How can Rheumatoid Lung Disease be Prevented?

Currently, there are no preventive methods reported for Rheumatoid Lung Disease.

• However, treating the underlying rheumatoid arthritis and decreasing its severity can help reduce the chances of developing Rheumatoid Lung Disease
• Close medical follow-up visits are necessary for individuals with RA, to assess damage to the lungs (if any)

What is the Prognosis of Rheumatoid Lung Disease? (Outcome/Resolutions)

• The prognosis of Rheumatoid Lung Disease is based on the severity of lung damage. In majority of cases, there is no severe damage to the lungs
• In some cases, extensive lung fibrosis may require lung transplantation. In such individuals, the prognosis is guarded
• If pulmonary hypertension develops, then the prognosis can be worse, especially if the patient does not respond to treatment

Additional and Relevant Useful Information for Rheumatoid Lung Disease:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/healthy-living/healthy-lungs/