Much is still not known about the connection between RA and ILD, but recent research has identified new risk factors.
RA-ILD may cause breathlessness and dry cough, but in many cases it causes no symptoms at all, making early detection difficult.
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The search for an effective treatment is ongoing, and management of the disease depends on whether the ILD is acute or chronic and whether there is evidence of inflammation or fibrosis (scarring or damage) in the lungs. According to research published in the Journal of Clinical Medicine in September 2021, in the case of chronic RA-ILD, “the arthritis of RA itself should first be stabilized without delay, and afterward, the activity of ILD itself can be stabilized, considering the safety of each antirheumatic drug for use in RA-ILD.”
Traditional DMARDs such as sulfasalazine and tacrolimus are “thought to provide some safety for the lungs” noted the researchers in the Journal of Clinical Medicine. Biologics such as abatacept (Orencia) and rituximab (Rituxan) may also be used. A JAK inhibitor, tocilizumab (Actemra), and a tumor necrosis factor inhibitor might be considered as well. A class of drugs called antifibrotics, which includes nintedanib, may be used in cases of fibrosis.
According to the Arthritis Foundation, depending on how advanced the ILD is, other treatment options may include corticosteroids and oxygen therapy. In some cases, a lung transplant may be necessary.
Inflammation, like the kind caused by RA-ILD, can lead to pulmonary fibrosis, or permanent scarring of the respiratory tissues. This can cause shortness of breath, since healthy air sacs are replaced by scar tissue that is not fully functional. Supplemental oxygen can help make breathing easier but will not reverse the damage done by pulmonary fibrosis.
Rheumatoid arthritis can also cause nodules to form in the throat and on the vocal cords, causing complications like hoarseness, shortness of breath, and other changes. Nodules can develop in the lungs as well but usually don’t cause symptoms, notes the Mayo Clinic, and patients may never notice them.
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According to the abovementioned European Respiratory Review, people living with rheumatoid arthritis also face a risk of:
Don’t wait for experts to understand the “why” behind RA-related lung problems. Get your protective action plan in gear now with these eight tips:
“We are still working to understand the natural history of lung involvement in RA and how exactly medication may be involved. At this point, I would encourage early screening for lung involvement for patients with signs and symptoms,” says Sparks. “If you have RA and are experiencing shortness of breath, coughing, or other respiratory symptoms, talk to your doctor. These are potentially serious symptoms that warrant prompt attention.”
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According to the Arthritis Foundation, people with RA who smoke are more apt to develop ILD. To get help with quitting, go to the SmokeFree.gov website.
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There seems to be a tight connection between the lungs and joints in RA, so it's very important to eliminate inhalants, such as pesticides, airborne chemicals, and air pollution as much as possible. “Most of the research has focused on the detrimental effects of cigarette smoking on both the joints and lungs, but it makes sense that the others are likely unhealthy as well,” says Sparks.
Have you gotten a flu shot this year? Have you discussed the pneumonia vaccine with your doctor? Preventing infection is better than treating infection, since there may be damage to the lungs. Sparks explains: “The flu, pneumonia, and COVID-19 vaccines are effective, and all patients with RA are strongly advised to receive them, particularly if on immunosuppressive medication, which might make them more susceptible to infection. If infected, [lung disease] could become more severe,” notes Sparks, while the vaccines will make infections milder.
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Exercise for lung health in RA has not been extensively studied yet, but regular exercise provides health benefits for your whole system.
Some RA drugs are immunosuppressive and may cause infections in the lungs. “No one really knows for sure how treatment for RA affects the lungs, either positively or negatively. Patients are encouraged to talk with their provider to make sure that the medications are optimal for their joint symptoms and their lung health,” says Sparks.
Persistent cough can be caused by any of the lung diseases and conditions mentioned above. If you let it go and it turns out to be due to infection, the infection will get worse.
“A supportive environment is essential to encourage physical activity, smoking cessation, and helping to lead a full and fulfilling life,” says Sparks.
Additional reporting by Deborah Shapiro.
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