Rheumatoid Arthritis and NTM Lung Disease: Understanding the Connection

Rheumatoid Arthritis (RA) is widely known as a chronic autoimmune condition that primarily affects the joints. However, many patients and even some caregivers are surprised to learn that RA can also affect the lungs—and that people living with RA may face a higher risk of developing Nontuberculous Mycobacterial (NTM) lung disease.

Understanding this connection is essential for earlier diagnosis, safer treatment decisions, and better long-term outcomes.

What Is Rheumatoid Arthritis (RA)?

Rheumatoid Arthritis is an autoimmune disease in which the immune system mistakenly attacks healthy tissue, leading to inflammation, pain, and joint damage. RA is a systemic condition, meaning it can affect organs beyond the joints, including the lungs.

Many people with RA require long-term treatment with medications that suppress the immune system in order to control inflammation and prevent joint damage.

What Is NTM Lung Disease?

Nontuberculous Mycobacteria (NTM) are environmental bacteria commonly found in water, soil, and dust. In some individuals, these bacteria can cause a chronic and progressive lung infection known as NTM lung disease.

NTM lung disease often develops slowly and may cause symptoms such as:

• Chronic cough
• Fatigue
• Shortness of breath
• Weight loss

Because symptoms can overlap with other lung conditions, NTM lung disease is frequently underdiagnosed or misdiagnosed.

How RA and NTM Lung Disease Are Connected

1. Immune-Suppressing RA Medications Increase Infection Risk

Many RA treatments—including biologic therapies, corticosteroids, and disease-modifying antirheumatic drugs (DMARDs)—work by suppressing the immune system. While these medications are effective for controlling RA inflammation, they can also reduce the body’s ability to fight infections.

Research has shown that certain biologic therapies, particularly anti-TNF medications, are associated with an increased risk of NTM infections. When the immune system is suppressed, environmental bacteria like NTM can more easily establish infection in the lungs.

2. RA-Associated Lung Disease Creates Vulnerability

RA can directly affect the lungs, even in patients who have never smoked. RA-related lung involvement may include airway inflammation, interstitial lung disease, or structural changes to the lungs.

These changes can impair normal lung defenses, making it easier for bacteria such as NTM to colonize and cause infection.

3. Bronchiectasis: A Shared Risk Factor

Bronchiectasis—a chronic condition in which the airways become widened and damaged—is strongly associated with both RA and NTM lung disease.

In bronchiectasis, mucus builds up in the airways, creating an environment where bacteria can thrive. People with RA are more likely to develop bronchiectasis, and bronchiectasis is one of the strongest known risk factors for NTM lung disease.

This creates a cycle in which:

• RA contributes to airway damage
• Airway damage increases infection risk
• Chronic infection worsens lung function over time

4. Diagnostic and Treatment Challenges

When RA and NTM lung disease coexist, diagnosis and treatment become more complex. Respiratory symptoms may be attributed to RA-related lung disease rather than infection, delaying proper diagnosis.

In addition, treating NTM lung disease may require adjusting or temporarily stopping immune-suppressing RA medications, which can be challenging for patients managing joint symptoms.

Close collaboration between rheumatologists, pulmonologists, and infectious disease specialists is often necessary.

Why Awareness Matters

Many people living with RA are unaware of the potential connection between autoimmune disease, immune suppression, and chronic lung infections. Increased awareness can lead to:

• Earlier evaluation of persistent respiratory symptoms
• Timely imaging and sputum testing
• More informed treatment decisions
• Improved quality of life and outcomes

If you or a loved one has RA and experiences ongoing cough, fatigue, or recurrent lung infections, it is important to discuss these symptoms with a healthcare provider.

Supporting Patients Through Education and Research

Education and research play a critical role in improving outcomes for people living with RA and NTM lung disease. By increasing awareness of risk factors and encouraging early evaluation, patients and clinicians can work together to protect lung health and guide safer, more effective care.

If you are living with RA, caring for someone with RA, or working in healthcare or research, staying informed about these connections can make a meaningful difference.

Learn more, stay informed, and help raise awareness about NTM lung disease and its connections to autoimmune conditions like RA.