Pathophysiology: When RA Decides to Play in the Lung Field

Rheumatoid arthritis (RA) is notorious for wreaking havoc on our joints. But it’s not restricted to just the joints; the pathophysiology can have implications on our lungs too.

Rheumatoid Arthritis and Lung Disease: A Chicken or the Egg Dilemma

Interestingly, the relationship between rheumatoid arthritis and lung disease is rather symbiotic. RA can lead to lung diseases. Conversely, lung disease, particularly interstitial lung diseases, can sometimes predate and even herald the onset of RA. It’s a bit like asking, “Which came first, the chicken or the egg?”

Rheumatoid arthritis and the lungs: The Mystery of Citrullination

Central to this conundrum is the process of citrullination. In our lungs, external agents like smoking or infections can trigger an inflammatory response. This leads to citrullination, where specific proteins in our lung cells are altered. This alteration can, unfortunately, make our immune system recognise these proteins as foreign. And this misrecognition? It prompts the production of anti-citrullinated protein antibodies, heavily implicated in RA. It’s like a classic case of mistaken identity with far-reaching consequences.

RA’s Lung Disease Portfolio

Rheumatoid arthritis has a knack for being linked with various lung conditions:

  1. Bronchiectasis: This involves abnormal widening of the bronchi, leading to mucus build-up and recurrent infections. It’s as if the lung’s airways are overstretched, losing their original elasticity.
  2. Interstitial Lung Diseases: RA can be a pesky trigger for this group of disorders, leading to scarring and thickening of the lung tissue. Imagine a sponge becoming less spongy, making it harder for oxygen to cross into the blood.
  3. Rheumatoid Nodules and Caplan’s Syndrome: These are lumps or nodules formed in the lungs, often seen in people exposed to certain types of dust. Think of them as tiny invaders that occasionally settle in the lung fields.

Treating RA and Its Lung Manifestations: A Balancing Act

Treatment options for rheumatoid arthritis, especially when there’s lung involvement, need meticulous planning.

  1. Immunosuppressants: These are drugs that tame the overactive immune system. While they can control RA and its lung implications, they also decrease the body’s ability to fight off infections, making the lungs more susceptible. It’s a bit like calming down a hyperactive child but risking them becoming too lethargic.
  2. Biological Therapies: These modern treatments specifically target the immune system components causing RA. While they’re often brilliant at their job, they can again raise the risk of infections, particularly in the lungs.

Pulmonologists and Rheumatologists: The Dynamic Duo

Given the complex interplay between rheumatoid arthritis and the lungs, it’s imperative for pulmonologists and rheumatologists to work hand-in-glove. Their combined expertise ensures that the joint and lung manifestations of RA are managed holistically. Think of them as Batman and Robin, both vital and complementing each other perfectly.


The realm of rheumatoid arthritis and the lung is vast and intricate. As science continues to unravel the complexities, understanding the multifaceted relationship between RA, lung disease, and their treatments becomes increasingly crucial.

Staying informed, consulting experts, and proactive management are our best allies. Look after your joint and lung health, and we hope that you keep breathing easy while staying nimble.


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Disclaimer: The information provided in this article is for informational purposes only and is not a substitute for professional personalised medical advice, diagnosis, or treatment. Always seek the advice of your healthcare provider with any questions you may have regarding a medical condition or treatment

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