Have a cough that won’t quit? Been short of breath lately? It could be a nasty cold or flu virus, or the problem could be related to your rheumatoid arthritis (RA). RA attacks the joints, but it doesn’t always stop there. It can affect other organs, including the lungs. In fact, some 20 to 30 percent of RA patients will eventually develop RA-related lung disease. Doctors may classify a lung problem as restrictive lung disease (such as interstitial lung disease) or obstructive lung disease (such as chronic obstructive pulmonary disease or asthma). Both result in shortness of breath.
ILD is most common. Caused by lung scarring, it makes it harder to fully inhale. RA patients whose disease is very active or severe are more prone to ILD. It’s also more frequent in men. Certain forms can be serious, even deadly. Less often, RA patients develop other lung problems, such as chronic obstructive pulmonary disease (COPD), that make it harder to fully exhale. Smokers are more prone to these types of lung problems. Symptoms of rheumatoid lung disease can be as obvious as coughing or shortness of breath, or they can be subtle. “There can be just fatigue while doing exercise,” says Tim Bongartz, MD, associate professor of medicine at Mayo Clinic in Rochester, Minn. “Maybe the patient can’t get as far as she used to get” when walking down the street.
“It’s important that providers are aware of the possibility that these subtle symptoms could indicate lung involvement,” says Dr. Bongartz. Much more rarely, RA can attack joints in the larynx, or voice box, and cause hoarseness, pain during swallowing or talking, a feeling of having something stuck in your throat, lowering of the voice or shortness of breath. Several decades ago, RA-related larynx problems were more common. But thanks to medications that keep RA more firmly in check, they are now “very rare,” says Dr. Bongartz. They usually happen in people with very active, hard-to-control RA.
Not only can RA cause lung problems, so can drugs used to treat it. Methotrexate, a first-line RA treatment, is a known culprit. It’s also possible that certain biologics, particularly tumor necrosis factor (TNF) inhibitors, may make lung problems worse in certain patients, although more research is needed. The solution may be to change dosages or medications, says rheumatologist Simon M. Helfgott, MD, associate professor of medicine at Harvard Medical School in Boston. And if you smoke, it’s time to stop.
If you’re having respiratory or throat symptoms, tell your doctor. He’ll examine you and may give you a lung function (spirometry) test and send you for an X-ray or CT scan. For throat problems, he may send you to an ear, nose and throat doctor.