What are the key pulmonary manifestations of rheumatoid arthritis that I should be aware of in my patients?

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 ³ (Groseanu and 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 ³ (Atzeni et al., 2025). Pleural involvement may manifest as pleural effusions or thickening, which can be asymptomatic or cause chest pain and breathlessness ³ (Boyle et al., 2025). Airway disease includes bronchiectasis and bronchiolitis, contributing to chronic cough and recurrent infections ³ (Atzeni et al., 2025). Rheumatoid pulmonary nodules, although less common, can mimic malignancy or infection and require careful evaluation ³ (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 ³ (Groseanu and Niță, 2024).