Improving Psychological Well-Being and Quality of Life in Rheumatoid Arthritis-Associated Interstitial Lung Disease Through Exercise and Pulmonary Rehabilitation: A Narrative Review.

Background

Rheumatoid arthritis-associated interstitial lung disease (RA-ILD) is a significant extra-articular manifestation of rheumatoid arthritis that contributes to morbidity, functional limitation, exertional dyspnea, fatigue and reduced quality of life. Current pharmacologic therapies address inflammatory and fibrotic pathways but do not target deconditioning, ventilatory inefficiency, skeletal muscle dysfunction or the high burden of anxiety, depression, impaired emotional well-being and reduced daily functioning.

Objective

To synthesize the evidence supporting the use of structured exercise and pulmonary rehabilitation (PR) on functional, psychological and quality of life outcomes in RA-ILD patients by integrating findings from RA-ILD cohorts, interstitial lung disease (ILD) PR trials, and rheumatoid arthritis (RA) exercise interventions.

Methods

A structured narrative review was conducted using PubMed, Scopus, and Web of Science (1990-2025). Of the 1240 identified records, 32 studies met inclusion criteria, comprising 4 RA-ILD observational cohorts, 17 ILD PR trials and 11 RA exercise trials. No randomized controlled trials specifically evaluating PR in RA-ILD were identified. Available evidence was extrapolated from studies in general ILD and RA populations. Mechanistic and physiological literature was included to contextualize findings.

Results

RA and ILD cohorts demonstrated markedly reduced six-minute walk distance, impaired diffusing capacity, exertional desaturation, fatigue, high anxiety and depression, and diminished daily function. Across seventeen PR trials, patients with idiopathic, autoimmune-associated, and fibrotic ILD showed improvements in exercise capacity, ventilatory efficiency, dyspnea, fatigue, psychological distress, emotional well-being, and health-related quality of life. Eleven RA exercise studies demonstrated improved aerobic capacity, strength, lean mass, fatigue, psychological outcomes (including anxiety), and function, with no increase in disease activity.

Conclusions

Evidence from ILD PR and RA exercise literature suggest that structured rehabilitation has the potential, alongside pharmacological therapy, to address functional limitation, dyspnea, fatigue and psychological distress and overall quality of life in RA-ILD, though disease-specific trials are needed.