Which pulmonary manifestation can occur with rheumatoid arthritis?

• A. Interstitial lung disease
• B. Pulmonary embolism
• C. Pneumothorax
• D. Pneumonia

Answer: (A)

Lung involvement can occur as an extra-articular feature of rheumatoid arthritis, reflecting how chronic autoimmune inflammation can affect organs beyond joints. The most characteristic pulmonary manifestation is interstitial lung disease, where ongoing inflammation leads to fibrosis of the lung interstitium. This condition often presents with gradually worsening shortness of breath and a dry cough, and on examination you might hear fine bibasilar crackles. High-resolution imaging typically shows diffuse interstitial changes, frequently with basilar and subpleural distribution, and a pattern that can resemble usual interstitial pneumonia. RA-associated interstitial lung disease is a major contributor to morbidity and mortality in rheumatoid arthritis.

Other options can occur in RA but are not classic direct pulmonary manifestations of the disease. A pulmonary embolism is a vascular event that can be more common in RA due to inflammation and immobility, but it isn’t a primary lung manifestation of RA. Pneumothorax and pneumonia can occur for various reasons, including infections or damage from multiple conditions, but they are not characteristic RA lung involvements.