What is RA-ILD?

RA-ILD stands for rheumatoid arthritis interstitial lung disease.

Rheumatoid arthritis is an autoimmune condition affecting mostly the small joints of the hands, but can also affect other organs of the body such as the lungs.

It is an autoimmune condition because it involves an abnormal immune reaction directed towards the body’s own healthy tissues. Most often, rheumatoid arthritis is associated with the production of an autoantibody called anti-cyclic citrullinated peptide (anti-CCP). Another blood marker called rheumatoid factor (RF) is also commonly elevated. Antibodies are proteins produced by the immune system cells to direct the immune reactions – we call them “auto” when the response is directed towards healthy tissues.

Rheumatoid arthritis mostly affects the hands where it can lead to joint pain, loss of function and distortion. In most cases, these symptoms lead patients to consult a rheumatologist who may prescribe various anti-inflammatory treatments for this. Subsequently, lung symptoms such as shortness of breath on exertion and coughing may also develop, leading to the discovery of an interstitial lung disease. In most cases, the lung problems are actually directly related to the rheumatoid arthritis, and this condition is then called RA-ILD. In some cases, lung abnormalities may actually occur a few years before the onset of joint disease, making the diagnosis quite complicated.

RA-ILD can be a serious condition associated with lung fibrosis (scarring). The fibrosis may progress over the years despite rheumatoid anti-inflammatory treatments for the joints. In these cases, loss of lung function would occur over time, leading to eventual respiratory failure. Certain treatments for rheumatoid arthritis actually work better on the lung component than others, so a joint approach between the rheumatology and respiratory/pulmonary teams is ideal to ensure that the most appropriate treatment can be given. If the lung fibrosis worsens over time despite rheumatoid treatments, additional medication called “antifibrotic“ can be given to slow down the lung decline. Your healthcare team will advise you if this is appropriate in your case.