About a third of people with RA will develop some type of lung or pulmonary symptom. Pleurisy, an inflammation of the lung lining, can make it painful to take a deep breath but is treatable with anti-inflammatory drugs. Some people with RA develop scarring called pulmonary fibrosis, which leads to progressive shortness of breath. Rheumatoid nodules might form in the lungs, but are usually harmless.

RA drugs may affect the lungs as well. Methotrexate can cause a complication known as methotrexate lung or methotrexate pneumonia, which generally goes away when the methotrexate is stopped. Less common drugs, including injectable gold and penicillamine, can cause similar pneumonias. The condition goes away when treatment ceases; patients can usually resume the drug in a few weeks.

The risk of contracting tuberculosis (TB – a bacterial infection of the lungs), is elevated in people with RA and intensifies among those taking corticosteroids, DMARDs and biologics. Your doctor should test for TB before initiating treatment and periodically after.


Research shows that people with RA are about 2.5 percent more likely to develop cardiovascular disease than the general population. Researchers suspect it’s because the inflammation that characterizes RA spreads to blood vessels. RA can also cause pericarditis, inflammation of the heart lining, which may manifest as chest pain. In general, people with RA should address lifestyle factors associated with heart disease such as eating a healthy diet, exercising and not smoking.


Though there’s no direct link between RA and the liver, medications can affect this vital organ. Studies show that long-term use of the analgesic acetaminophen (Tylenol) is considered a leading cause of liver failure. Liver diseases may also occur with long-term methotrexate use. Working with your rheumatologist to monitor your blood is key to preventing problems.


Kidney problems are more likely related to side effects of RA drugs – such as cyclosporine or an NSAID – than to the disease itself. If you're taking one of these drugs or methotrexate, which concentrates in the kidneys, your doctor will monitor your kidney function to watch for problems.