Rheumatoid Arthritis Affects Lungs: Check Symptoms, Treatment And Prevention

Rheumatoid arthritis is more than just a joint disease. There are effective treatments available and therefore early diagnosis is important to limit or prevent permanent damage.

Rheumatoid arthritis (RA) is a common inflammatory disease of the joints. It affects multiple joints, mainly the small joints of the hands and wrists but also the larger ones. It causes joint pain with stiffness that is usually more in the morning and progresses over time, leading to joint deformities and ultimately a disabling state. Effective treatments are available and therefore early diagnosis and regular treatment with monitoring of disease activity are important to limit or prevent permanent damage.

Can rheumatoid arthritis cause lung disease?

RA is more than just a joint disease. The inflammatory process also affects various other parts of the body. The most frequently affected are the lungs, as well as the skin, eyes, digestive system, heart and blood vessels. Pulmonary conditions that occur in patients with RA are of various types. More than 25 percent of RA patients will eventually develop lung conditions and diseases in their lifetime. If all RA patients are screened for lung disease, even when there are no pulmonary symptoms, more than half are found to have evidence of lung involvement.

Lung disease follows only heart disease and cancer as the cause of death in RA patients. Lung disease due to RA is an important factor contributing to poorer quality of life, in addition to mortality. Most often, lung disease follows joint involvement, but rarely, RA may begin as lung disease, and joint manifestations may appear later.

What are the different lung diseases caused by rheumatoid arthritis?

The most common lung disease caused by rheumatoid arthritis is a contraction of the lungs, called interstitial lung disease (ILD). Other lung conditions and diseases that can occur in RA include pulmonary nodules (one or more round masses of tissue, of various sizes, that confuse the possibility of lung cancer), pleural effusion (protein-rich fluid in the sac surrounding the lungs), pleural effusion thickening, bronchiectasis (dilation of the lung airways leading to accumulation of secretions and lung infections), bronchiolitis (narrowing of the airways deep in the lungs), pulmonary hypertension (high blood pressure in the pulmonary arteries) and increased tendency to lung infections such as pneumonia. Drugs used to treat RA generally suppress immunity, increasing the risk of lung infections.

What is interstitial lung disease?

PIDs are a group of conditions with diverse causes that have in common a reduction in the size of the lungs due to fibrosis that usually worsens over time. RA is one of the most common causes of an ILD. There are several types of EPI patterns, and the treatment, prognosis, and natural history differ depending on the EPI pattern.

A patient with ILD develops shortness of breath on exertion, initially while running or walking fast, especially when going uphill. It progresses over time, and ultimately even activities of daily living, such as dressing, bathing, or even eating, cause shortness of breath. Oxygen levels in the blood decrease, in the early stages of exertion, and later, even at rest. These patients require oxygen at home to keep their oxygen in the normal range. Dry cough is the other major symptom. Patients with ILD sometimes have sudden flare-ups, called acute exacerbations, which acutely worsen respiratory failure and carry a high risk of mortality.

Men, smokers, those with a long history of joint disease, more active joint disease, and older age are more likely to develop PID, but many RA patients without any of these risk factors can also develop PID.

How is PID diagnosed and treated?

ILD is diagnosed by features on examination of the chest, breathing tests called spirometry and diffusing capacity, and imaging including a plain chest x-ray and a high-resolution computed tomography (HRCT) scan of the chest that provides the ILD pattern key. In a case where the diagnosis of RA is already established by clinical features and characteristic blood tests, a lung biopsy is not required. Some of these tests are required from time to time after treatment is started to assess the response and progress of the disease.

Treatment of RA PID has variable efficacy and may result in relief of symptoms.

This is in addition to medications given for other RA symptoms, including joint disease. While there are now effective treatments available for RA depending on the severity and extent of the disease, treating lung diseases such as PID is more difficult. Medications that work for the joints don’t seem to work for the lungs in general. Drugs such as corticosteroids that suppress immune-mediated immune damage have a variable response. For those who have increased lung fibrosis, a new class of drugs called antifibrotics can help slow the increase in contraction. Fibrosis is not reversible.

What are the treatments for other lung diseases due to rheumatoid arthritis?

Management of a large pleural effusion would require chest tube drainage or video-assisted thoracoscopy, which is minimal access surgery. Treatment of lung infections requires appropriate antibiotics. Narrowing of the airways in the lungs requires inhaled medications.

In addition to medications, breathing exercises and nutritional supplements are provided as needed as part of what is called pulmonary rehabilitation. This reduces breathlessness and improves exercise tolerance. Patients who cannot maintain a normal blood oxygen level, which can be easily measured with a pulse oximeter and blood gas analysis, require 24-hour oxygen therapy. This can be done using oxygen concentrators. Portable machines are also available.

The last resort for extensively scarred lungs is lung transplantation, a highly specialized and expensive surgery now increasingly available in different cities across India.

How can patients with Rheumatoid Arthritis detect that they have a lung problem?

Once RA is diagnosed, an evaluation for the presence of lung disease is recommended, as early lung disease may not produce any symptoms. Subsequently, any onset of prolonged cough, sputum production, and, most importantly, dyspnea with reduced exercise tolerance, warrants evaluation for a possible pulmonary complication. Early diagnosis is the best promise for a good response.

(Enter IANS)