Does smoking increase the risk of interstitial lung disease in psoriatic arthritis?

Interstitial lung disease (ILD) is a group of lung conditions that cause scarring and inflammation, making it harder to breathe. While ILD is not a classic complication of psoriatic arthritis (PsA), research shows it may be more common than previously thought. Smoking appears to increase this risk. A 2026 meta-analysis found that smoking was significantly associated with ILD in people with PsA ³¹⁰. This means that if you have PsA and smoke, your chances of developing ILD are higher.

What the research says

A 2026 systematic review and meta-analysis pooled data from six studies involving over 14,000 patients with PsA. It found that the overall prevalence of ILD in PsA was about 3% ³¹⁰. However, when doctors used CT scans to diagnose ILD, the rate was higher at 6% ³¹⁰. The same analysis identified smoking as a significant risk factor for ILD in PsA patients ³¹⁰. Another large database study from 2025 compared PsA patients to the general population and found that PsA patients had nearly double the risk of developing ILD (risk ratio 1.94) ⁹. That study also adjusted for smoking, meaning the increased risk was not just due to smoking habits ⁹. Together, these findings suggest that both having PsA and smoking contribute to ILD risk.

What to ask your doctor

• Given my PsA, what is my personal risk for interstitial lung disease?
• Should I be screened for ILD with a chest X-ray or CT scan, especially if I smoke?
• What steps can I take to reduce my risk of lung problems, including quitting smoking?
• Are there any medications for my PsA that might affect my lungs?
• What symptoms of ILD should I watch for, like shortness of breath or a dry cough?