Key pulmonary manifestations of rheumatoid arthritis (RA) include interstitial lung disease (ILD), pleural disease, airway disease, and pulmonary nodules. ILD is the most significant and common pulmonary complication, often presenting with symptoms such as exertional dyspnoea and a non-productive cough, and can lead to progressive respiratory impairment NICE NG100 Groseanu & Niță 2024. The predominant ILD patterns associated with RA are usual interstitial pneumonia (UIP) and nonspecific interstitial pneumonia (NSIP), with UIP linked to a worse prognosis NICE NG100 Atzeni et al. 2025. Pleural involvement may manifest as pleural effusions or thickening, which can be asymptomatic or cause chest pain and breathlessness NICE NG100 Boyle et al. 2025. Airway disease includes bronchiectasis and bronchiolitis, contributing to chronic cough and recurrent infections NICE NG100 Atzeni et al. 2025. Rheumatoid pulmonary nodules, although less common, can mimic malignancy or infection and require careful evaluation NICE NG100 Boyle et al. 2025. Early recognition and monitoring of these pulmonary manifestations are crucial due to their impact on morbidity and mortality in RA patients NICE NG100 Groseanu & Niță 2024.
Key References
- NG12 - Suspected cancer: recognition and referral
- CG163 - Idiopathic pulmonary fibrosis in adults: diagnosis and management
- NG100 - Rheumatoid arthritis in adults: management
- (Groseanu and Niță, 2024): A Systematic Review of the Key Predictors of Progression and Mortality of Rheumatoid Arthritis-Associated Interstitial Lung Disease.
- (Atzeni et al., 2025): Interstitial lung disease in rheumatic diseases: an update of the 2018 review.
- (Boyle et al., 2025): Systemic autoimmune rheumatic diseases-associated interstitial lung disease: a pulmonologist's perspective.