What is rheumatoid arthritis with interstitial lung disease (RA-ILD)?
RA is a systemic autoimmune disease. Besides the joints, it also affects other parts of the body, including lungs.1
RA-ILD stands for rheumatoid arthritis with interstitial lung disease. Rheumatoid arthritis (RA) is a condition that affects about 1% of the population worldwide. Of these people with RA, 10-20% will develop lung involvement known as interstitial lung disease (ILD). 1 In this form of ILD, scarring of the lung tissue might develop. This scar tissue is known as pulmonary fibrosis and affects the tiny air sacs and blood vessels responsible for providing oxygen to all parts of the body. As healthy lung tissue is replaced by scar tissue, it becomes harder for oxygen to pass through the lungs and into the bloodstream. This results in a shortness of breath2,3
Symptoms of RA-ILD
Most people don’t notice the changes to their lungs at first as they may already be feeling fatigued and out of breath due to their underlying RA. However, these can also be a symptom of ILD and so it’s important to be aware of your body’s capabilities and notice any changes.
The earlier lung involvement is spotted, the sooner you can be tested and get support as your doctor can decide the best way forward for your individual situation.
Symptoms of RA-ILD may include: 2
- Shortness of breath
- Feeling more out of breath than usual when climbing stairs
- Difficulty taking deep breaths
- A worsening, dry cough
- Feeling more tired than usual when going about your normal day
There are a variety of symptoms you may experience with RA-ILD and some of these will worsen as your disease progresses. Keep in mind that there are lifestyle changes and different treatments that can help you manage them. Symptoms can also vary from one person to another, so your symptoms may not be the same as somebody else who has pulmonary fibrosis.
Keep a diary of your symptoms to track how you feel over time. Also, make a note of any questions and be sure to share your symptoms with your doctor
How is RA-ILD diagnosed?
When diagnosing RA-ILD, your treatment team will look at many areas of your health. For example, they will ask you about your work history, family medical history, any potential drug and medication use and whether you have ever smoked.
A physical examination is also used to give the doctor a better understanding of your lung health. However, other tests may be needed to make a clear diagnosis.2
Progression of RA-ILD
RA-ILD can become progressive, which means that it might get worse over time. However, currently there is no way of predicting if, or how fast this will happen. Some patients might not have changes in their symptoms, while other patients might experience a faster worsening of their symptoms. There are signs that can mean the disease has progressed but your doctor, supported by a wider team of specialists, will work closely with you to monitor this. 4
Talk to your doctor about treatment options for RA-ILD. They will be best able to provide guidance and support tailored to your individual situation and suggest the best way moving forward
Some days may be tougher than others. Regardless of how you’re feeling we can point you in the direction of help.
Join a support group, if somebody puts out a hand to help, somebody will always hold it
- RA is an autoimmune disease. ILD can occur in patients with RA, which means that the lungs might become scarred resulting in shortness of breath
- When looking for the correct diagnosis, your treatment team may perform several tests to get a good understanding of your lung health
- RA-ILD might become progressive and so your doctor, supported by a wider team of specialists, will work with you to monitor changes in your symptoms
Olson A, Gifford A, Inase N, et al. The epidemiology of idiopathic pulmonary fibrosis and interstitial lung diseases at risk of a progressive-fibrosing phenotype. Eur Respir Rev. 2018;27(150):180077.
British Lung Foundation. Pulmonary Fibrosis. Available at:
https://www.blf.org.uk/support-for-you/pulmonary-fibrosis. [Accessed April 2019].
Shaw M, Collins B, Ho L, Raghu G. Rheumatoid arthritis-associated lung disease. Eur Respir Rev. 2015;24(135):1–16.
Zamora-Legoff JA, Krause ML, Crowson CS, et al. Progressive Decline of Lung Function in Rheumatoid Arthritis-Associated Interstitial Lung Disease. Arthritis Rheumatol. 2017;69(3):542–549.