Pulmonary fibrosis and rheumatoid arthritis: What’s the link?

Rheumatoid arthritis (RA) is an autoimmune inflammatory disorder that causes chronic pain in the joints. RA can also affect other organs, such as the lungs, causing severe breathing problems.

The risk of developing pulmonary fibrosis is higher in people who:

• are frequent smokers
• often come into contact with environmental pollution
• have a family history of pulmonary fibrosis
• regularly use anti-inflammatory medication

Doctors still do not fully understand the link between RA and pulmonary fibrosis, but evidence shows that as many as 40 percent of people with RA have pulmonary fibrosis.

Symptoms

Symptoms of RA vary in type and severity and may come and go.

When the disease is active, it is known as a flare. During a flare, symptoms can vary in duration and intensity.

Common symptoms of RA include:

• morning stiffness that lasts for 30 minutes or longer
• tenderness, pain, or swelling in the joints, lasting 6 weeks or longer
• pain in joints on both sides of the body
• pain in smaller joints, such as the hands, wrists, and feet

When RA leads to lung problems, people may experience the following symptoms:

• shortness of breath
• dry persistent cough
• frequent feeling of tiredness
• sudden, unexplained weight loss

Doctors diagnose RA by asking about a person’s medical history, doing a complete physical examination, and ordering a series of imaging and blood tests.

These tests check for:

• swollen joints
• the degree of pain a person is experiencing
• the presence of antibodies in the blood called rheumatoid factor
• bone and joint abnormalities

Common tests to diagnose RA include:

• Erythrocyte sedimentation rate (ESR): A test measuring how quickly red blood cells settle to the bottom of a test tube. The ESR test indicates the presence of an inflammatory condition, such as RA, but cannot diagnose RA on its own.
• C-reactive protein (CRP) test: A test that indicates the level of C-reactive protein in the blood. Higher levels of CRP in the blood may indicate inflammation or infection in the body.
• Complete blood test: A test to check for anemia. A 2017 study in the World Journal of Pharmaceutical and Medical Research reported that 60 percent of Sudanese people with RA in the study also had anemia.

Diagnosing pulmonary fibrosis

A doctor will request one or more of the following tests to help diagnose pulmonary fibrosis.

• pulse oximetry
• pulmonary function test
• imaging tests, such as chest X-rays or computed tomography scans
• lung tissue biopsy
• arterial blood gas test

These tests show whether there is inflammation or damage in the lung tissue. They also measure the levels of oxygen, carbon dioxide, and air capacity in the lungs.

According to the National Rheumatoid Arthritis Society, people should see their doctor if they experience lung problems for more than 1 month.

They should also see a doctor if they experience sudden but regular severe breathlessness while doing everyday tasks.

The doctor will assess the extent of the problem and may make a referral to a specialist called a rheumatologist if necessary.

Treatment for RA and pulmonary fibrosis

Both RA and pulmonary fibrosis have no cure, so treatment goals aim to manage the symptoms and reduce the progression of the disease.

Medications and treatments to control RA-linked pulmonary fibrosis may include:

• anti-inflammatory medicines
• corticosteroids and immunosuppressants
• oxygen therapy to provide relief and enable easier breathing
• pulmonary rehabilitation therapy
• lifestyle changes, such as quitting smoking and increasing physical activity to strengthen the lungs

Outlook

RA-linked pulmonary fibrosis progresses differently from person-to-person. Some people experience worsening of symptoms within months, while in others, the disease may take a few years to advance.

Differences in progression may be because age, genetics, and lifestyle factors play a role in the development of both conditions.

According to a study in Clinical Medical Insights: Circulatory, Respiratory and Pulmonary Medicine the average life expectancy for someone with pulmonary fibrosis is 2.5 to 5 years, although this is merely an estimate drawn from large-scale population studies.

If a person has RA and experiences lung problems, they should talk to a doctor at the earliest opportunity about the nature and frequency of symptoms. Recent advances in medication and treatment have improved both management of symptoms and quality of life in the long-term.

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