Other than the joints and heart, the lungs are the part of the body most commonly affected by rheumatoid arthritis (RA). The lung complications associated with RA can be serious and even fatal, yet often cause no symptoms. The diagnosis of lung disease in RA patients can be challenging because the symptoms of lung problems overlap with the symptoms of heart disease.

Respiratory system

Rheumatoid arthritis-associated interstitial lung disease (RA-ILD) is the most serious and most common lung complication in people with RA. Symptoms relate to breathlessness and dry cough. Rheumatoid nodules can occur in the lungs of patients with RA. Pulmonary fibrosis, permanent scarring of the lungs, is another lung condition caused by inflammation and is often linked with RA-ILD. Methotrexate can cause pulmonary fibrosis, so people who take this drug should be monitored closely for lung disease. Pleurisy is an inflammation of the lining of the lungs, called the pleura. It occurs in more than half of all people with RA and can make breathing painful. It’s important to try to prevent RA-associated lung disease because of its high risk of complications.

The most important things you can do are to avoid smoking, or if you do smoke, ask your doctor for help quitting, and make sure you get regular checkups so that your doctor can listen to your lungs and monitor your breathing. If you have RA and are experiencing shortness of breath, coughing, or other respiratory symptoms, seek medical attention quickly.


Diabetes occurs when the body is unable to produce or use the hormone insulin sufficiently. Insulin converts the sugars we get from food into energy. Like rheumatoid arthritis (RA), diabetes is an autoimmune disease. In the case of diabetes, the body’s immune system attacks the cells of the pancreas that make insulin.

One of the medications often used for arthritis could also play a role, as it is well known that steroids can increase the risk of diabetes. However, studies show that other RA drugs may actually lower diabetes risk: the antimalarial drug hydroxychloroquine, which is typically used to treat mild RA, is associated with a lower risk of diabetes among people with RA, though it’s unclear why this is so. Other RA drugs known as TNF blockers and methotrexate have been shown to improve insulin resistance and lower diabetes risk, but more research is needed.

For people with RA who may be concerned about diabetes, it is important to maintain a healthy lifestyle. This includes exercise, eating a healthy diet that contains some protein, healthy fats, whole grains and non-starchy vegetables, maintaining a healthy weight, and not smoking.

Heart disease

Heart disease is a catch-all term that includes heart attack, irregular heartbeat, high blood pressure and atherosclerosis (the build-up of plaque in the arteries). Heart disease is the leading cause of death in rheumatoid arthritis (RA) patients, and if you have RA, you have a twofold increased risk for heart attack and stroke. For people who’ve had RA for 10 years or more, the risk rises to nearly threefold.

The reason for the increased risk of heart disease in arthritis patients, as is the case with some other arthritis co-conditions, is inflammation. Inflammation, regardless of its source, is a known risk factor for heart disease. The inflammation of arthritis does not act alone, however. There are other independent risk factors for heart disease that can be modified or controlled, such as smoking, high cholesterol, high blood pressure, inactivity, obesity and diabetes.

While we know that high cholesterol levels are associated with a higher risk of heart disease in everyone, cholesterol levels are more likely to be unstable in people with higher levels of inflammation and RA disease activity. This can lead to an even higher risk of heart attack for people with RA. In addition, some of the medications used for arthritis, such as prednisone, tocilizumab and NSAIDs, appear to increase heart disease risk, while other arthritis drugs offer heart protective benefits (including TNF inhibitors, methotrexate and hydroxychloroquine).


Anyone can have a stroke, which happens when blood flow to an area of the brain is reduced or cut off, causing brain cells to die. This occurs either because a blood clot blocks the blood flow or a blood vessel leaks or bursts.

Symptoms of stroke can include slurring speech, confusion, paralysis or numbness of the face, arm or leg, a sudden severe headache, trouble seeing in one or both eyes and difficulty walking. Depending on how severe the stroke is, the person can have mild problems such as temporary weakness of one of their limbs, or more severe, permanent effects such as paralysis on one side of the body or loss of the ability to speak. More than two thirds of people who have a stroke have some form of permanent disability.

Along with heart attack, stroke is the cause of many premature deaths in people with rheumatoid arthritis (RA). One study found that people with RA had a 67 percent higher risk of stroke than those without, though it remains unclear to what extent arthritis is an independent risk factor for stroke. The connection appears to be inflammation. Similar to heart disease, some studies show that inflammation, including the type that is associated with arthritis and systemic lupus erythematous, increases a person’s risk for stroke.

Additional risk factors for stroke include high cholesterol, diabetes, obesity, smoking, high blood pressure and carotid artery disease (in which the carotid arteries in your neck, which supply the brain with blood, become narrowed due to the build-up of plaque). If someone with RA has any of these other conditions, the risk of stroke becomes even higher.

People with RA should take care to reduce their risk of stroke, along with all forms of heart disease, by addressing the risk factors they can control – not smoking, losing weight, working to achieve healthy cholesterol levels, eating a balanced diet and exercising.

Permission:  Italian RA Society 2016

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