Ask the Doctors October 2006 Issue

Ask the Doctors (10/06)

Is there such a thing as arthritis of the lungs?  If so, what are its symptoms and how is it treated?


Although we usually think of arthritis as affecting the joints, rheumatoid arthritis can affect the lungs (rheumatoid lung disease) as well. It can cause inflammation of the lining of the lungs, which causes pain with breathing (pleurisy). Fluid may accumulate around the lungs (pleural effusion) and cause shortness of breath. Small lumps (rheumatoid nodules) also may form in the lungs. These are most frequent in patients who have nodules on other parts of the body, such as under the skin. Scarring of the connective tissue, which supports the air sacs of the lungs (pulmonary fibrosis), may also cause shortness of breath.

   The primary symptoms of rheumatoid lung disease are coughing, shortness of breath, chest pain, and fever. Chest X-rays or CT scans may be sufficient for diagnosis, but other tests, such as echocardiogram or bronchoscopy, may be necessary. Sometimes a crackling sound in the lungs can be heard with a stethoscope. Corticosteroids may be helpful to reduce inflammation and, of

course, to treat the underlying cause, rheumatoid arthritis.


I have stiffness and pain in my fingers, elbows, and hip if I sit for a long period of time.  How­­ever, there’s no swelling or redness, which I thought were symptoms of arthritis.


More than 100 types of arthritis have been identified, and the primary

symptoms in almost all forms are pain and stiffness. Osteoarthritis and rheumatoid arthritis are the most common types, and symptoms may help your doctor determine if you have either of these.

   When stiffness develops and how long it lasts are important clues. Mild morning stiffness is common in osteoarthritis and subsides after a few minutes of activity. In rheumatoid arthritis, however, morning stiffness may not begin to improve for an hour or longer. People with osteoarthritis often notice more stiffness during the day after resting for an hour or so.

   Pain and stiffness that develop gradually and intermittently over several months or years suggest osteoarthritis. Pain, stiffness, and fatigue that worsen over several weeks or a few months could be caused by rheumatoid arthritis or another form of inflammatory arthritis. Swelling, warmth, and redness of the skin over the joint are more common with rheumatoid or other types of inflammatory arthritis.


I have gout, and my doctor tells me not to take aspirin. Why?

Aspirin in doses of less than two grams per day (about six regular-strength aspirin) can raise uric acid levels (the chemical that causes gout).


Higher doses actually lower uric acid levels. If you are on a drug for gout called probenecid (Benemid), aspirin will inhibit its effect. Substances to avoid when you have gout include water pills (e.g. hydrochlorothiazide), alcohol, and foods that are organ-based, such as liver.


Recently I read in a health publication that white rice is bad for patients with osteo-arthritis. Is this true?


Although a number of publications have claimed that avoiding highly refined products--such as white rice, white bread, white pasta, and foods that contain trans-fatty acids--can have a beneficial effect on osteoarthritis, there is no medical basis for this claim and no scientific evidence to support it.


   A diet in which these foods are eliminated or kept to a minimum may

result in weight loss, which does have a beneficial effect on

osteoarthritis, and a healthy diet is essential for everyone. However, there has been no valid research linking diet directly to the development or progression of osteoarthritis.