Causes of dyspnea in autoimmune rheumatic disorders: beyond interstitial lung disease and pulmonary arterial hypertension

Pulmonary involvement is a common and serious complication of rheumatic diseases, significantly contributing to morbidity and mortality. Beyond the well-characterized interstitial lung disease and pulmonary arterial hypertension, patients may develop less common but clinically important respiratory manifestations, including pleural disease, airway disorders, alveolar hemorrhage, and thromboembolism. These conditions are often challenging to recognize due to their variable presentations and overlap with more typical complications. This review provides a current and comprehensive overview of respiratory symptoms in patients with autoimmune rheumatic diseases, excluding pulmonary arterial hypertension and interstitial lung disease, with a focus on less common but clinically significant entities. We discuss diagnostic approaches, including high-resolution imaging, pulmonary function tests, serological biomarkers, and, when necessary, tissue biopsy, that enable accurate identification of these rare complications. Increasing clinician awareness and adopting multidisciplinary care models are essential to optimize diagnosis and management. Recognizing these uncommon respiratory manifestations facilitates tailored interventions, helps preserve lung function, and improves overall prognosis. This review aims to serve as a practical guide for clinicians, ensuring that patients with systemic rheumatic diseases receive timely, thorough, and effective respiratory care.