Rheumatoid Arthritis's Impact on the Lungs and How to Protect Them

Rheumatoid arthritis’s causes are poorly understood by the medical community, but that doesn’t mean that patients shouldn’t be proactive in managing their RA and working to prevent flares.

Patients with RA should also be aware that it does not just affect their bones and joints. This autoimmune disease with its inflammatory processes can have impacts on other parts of the body as well, with RA-related lung problems being the most common.

If you or someone you know has RA, it is important that you work with your healthcare team to protect your lungs and prevent some of the following conditions from developing.

Interstitial lung disease (ILD): This is a group of disorders that are caused by inflammation and result in scarring of the lung tissue. This scarring builds up over time and can cause difficulties with breathing and could eventually lead to lung transplants.

Bronchiectasis: This is a condition where damage to the tubes that carry air to the lungs (airways) causes them to become flabby and scarred. This limits your ability to clear mucus out of the airways which can create an environment where bacteria is more likely to grow, thus resulting in infections.

Bronchiolitis obliterans: This is an inflammatory condition that affects the bronchioles. This can cause the bronchioles to become damaged and scarred and thus blocked.

Pleural effusion: This occurs when an abnormal buildup of fluid occurs between the lung and chest wall, also known as the pleural space. This can result in shortness of breath, chest pain, fever, and/or cough.

Pleurisy: This happens when the pleura (membrane that lines the lungs) becomes inflamed. It can cause sharp chest pain that becomes worse with breathing.

Pulmonary fibrosis: This is a disease that occurs when the lungs become damaged and/or scarred. This makes breathing difficult. As it worsens, so does shortness of breath.

Pulmonary hypertension: This is a type of high blood pressure that affects the arteries in the lungs and the right side of the heart. Some forms can be serious and even fatal.

Pulmonary nodules: Most of these are non-cancerous or benign, and if benign there are usually no symptoms. Around 10 percent are cancerous.

Daniel Libby, MD, professor of medicine at Weill Cornell Medicine in New York City, says while the exact connection between RA and these lung disorders still remains a mystery, it is likely inflammatory in nature. A recent article suggests that RA patients should immediately start working to protect their lungs.

They argue that you do not need to understand why RA affects your lungs negatively to take some action in protecting them. They offer 8 tips to help RA patients maintain healthy lungs.

1. The first step is to not ignore your RA. Once you are diagnosed it is important to get treatment, not only for your lungs but also for your joints and the rest of your body. Jeffrey A. Sparks, MD, assistant professor of medicine in the division of rheumatology, immunology, and allergy at Brigham and Women’s Hospital and Harvard Medical School suggests that since there is a correlation between RA and lung disorders, patients should be screened early on for changes in the lungs.
2. This one should go without saying, but the second recommendation is to not smoke and avoid secondhand smoke. Smoking has well-documented negative effects on lungs and the rest of the body. Whether you have RA or not, avoiding smoking can only benefit your health. Additionally, the Arthritis Foundation says that people who smoke and have RA are more likely to develop ILD.
3. Any other things that you could inhale that would be bad for your lungs should also be avoided. This means trying to limit your exposure to pesticides, airborne chemicals, and air pollution. While there has not been much research in this area, it makes sense that, since there is a known correlation between RA and the lungs, anything that harms the lungs could impact the patient’s overall health.
4. Get your flu and pneumonia vaccinations! Flu vaccines help people avoid severe complications and death every year. For people who have RA and could already have compromised lung functioning, it is important that they do everything they can to avoid further damage. Prevention is key, and for people who are on immunosuppressive medication, this is even more important.
5. Staying active has benefits for the whole body and is definitely important for maintaining strong lungs. If you are already an active person, keep it up! Just remember to listen to your body and not overdo it. You don’t want to throw yourself into a flare-up. If you are new to exercising, start slow. Talk to your provider about exercises that may work for you and your individual health situation. Also make sure you find something you enjoy so that you can stick with it!
6. While your healthcare provider should be monitoring what medications he or she is putting you on and what the side effects are, it is important that you are aware of what you are taking as well. Knowing the side effects and potentially serious adverse effects of the medications you are taking can help you stay healthy. Immunosuppressive medications can make it easier for you to get lung infections, so prevention is something you should be diligent about when taking these. Since RA is not well understood, the treatments involve some gaps in understanding as well. Sparks encourages patients to talk with their providers about their medications to make sure that both their joint and lung health is being optimized.
7. It is also important that, if you feel like you may be getting a lung infection, seek medical attention. If you have a cough or shortness of breath, treating the infection (if present) can help limit the amount of damage that it could do to your lungs.
8. Surround yourself with people who support you and will help you through the tough times. Sometimes it just takes a close friend or family member to hold you accountable to help you make a change. This can be particularly useful when you are trying to tackle something extra difficult like quitting smoking or starting an exercise routine!

Ultimately, taking a holistic approach to your health can only benefit you. This means looking at your RA, your lungs, and every other part of your body, and seeing how that fits into your lifestyle. By working with your healthcare team you can take a closer look at how your RA impacts your life, and how your life impacts your RA. This should be able to help guide you in making some healthy changes when necessary. There is no doubt that it is hard work to find the motivation to be proactive in our health (whether we have RA or not) when we have a thousand other things to worry about daily, and millions of distractions in our lives. However, it is possible and could greatly improve your quality of life. Don’t be afraid to ask for the support and help of people in your life!