Can Rheumatoid Arthritis Cause Difficulty Swallowing? Discover the Truth

Can rheumatoid arthritis cause difficulty swallowing? It’s not the first question most people think of when they hear “RA,” but it’s one that comes up more than you might expect — and one I’ve been asked in clinic quite a few times. As a rheumatology nurse practitioner, I’ve sat with countless patients who tell me something like, “My joints hurt, sure, but now I’m struggling with swallowing my pills — and sometimes even food.” Sound familiar? If it does, you’re not alone. Let’s dive into this lesser-known, but incredibly important, connection between rheumatoid arthritis and swallowing difficulties.

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How Rheumatoid Arthritis Can Affect More Than Just Joints

RA is known for causing inflammation in the joints, but what many people don’t realize is that it’s a *systemic autoimmune disease*. That means it doesn’t just pick on your knees, fingers, and wrists. It can also target your eyes, lungs, blood vessels — and yes, even the structures involved in swallowing.

I had a patient, we’ll call her Maria, who had lived with RA for over a decade. She came in not because of joint pain this time, but because she was suddenly choking on soft foods and struggling to get water down. At first, she thought it was unrelated. But once we started digging into her history and did a proper work-up, it became clear her RA was playing a bigger role than she realized.

Understanding the Link Between RA and Swallowing Issues

So, can rheumatoid arthritis cause difficulty swallowing? Absolutely — and the reasons behind it are actually pretty layered. Here are a few ways this can happen:

Cricoarytenoid Arthritis: This is inflammation of the tiny joints in your throat (larynx) that help control your vocal cords. When these joints swell, it can lead to pain, a hoarse voice, or a sensation of a lump in the throat.
Esophageal Dysmotility: RA can impact smooth muscle function, including the muscles in your esophagus. That means food might not move down the way it should — leading to that awkward, stuck feeling mid-swallow.
Medication Side Effects: Many RA medications, especially NSAIDs and corticosteroids, can irritate the esophagus or cause dry mouth, which makes swallowing tougher.

When I explain this to patients, I usually draw it out: imagine your esophagus is like a soft tube with muscles that contract in waves. If those muscles aren’t firing right, or if inflammation is getting in the way, the whole process breaks down.

Why These Symptoms Shouldn’t Be Ignored

Here’s the thing: difficulty swallowing might seem like a minor issue at first. But in patients with RA, it can be a red flag for more significant involvement of the disease. And trust me, I’ve seen it snowball.

If someone is dealing with silent aspiration (where food or liquid slips into the airway without triggering a cough), it can lead to recurrent pneumonia — especially in older adults. Add to that malnutrition, dehydration, or the emotional impact of avoiding food, and you’ve got a real quality-of-life problem on your hands.

RA-related swallowing issues are also often underdiagnosed. Sometimes, even physicians don’t make the connection unless the patient brings it up repeatedly. That’s why knowing the signs and advocating for yourself (or your loved ones) matters so much.

What Symptoms Might Point to a Swallowing Problem in RA?

Persistent hoarseness or voice changes
Frequent throat clearing or coughing during meals
Choking or feeling like food is stuck
Chest discomfort after swallowing
Weight loss without trying

In practice, I usually ask patients a few targeted questions about their eating habits, pill swallowing, and whether they’ve been avoiding certain foods. You’d be surprised how often people say “Actually, yeah, now that you mention it…”

When to Speak Up: Talking to Your Rheumatology Team

Look — I know it can feel weird to mention throat issues to your rheumatology provider when you’re there to talk about joints. But if you’re asking yourself, can rheumatoid arthritis cause difficulty swallowing?, you’re already on the right track. Don’t wait for it to get worse. Bring it up. We want to know. In fact, catching it early can help us coordinate care with ENT specialists, gastroenterologists, or speech-language pathologists who deal with swallowing issues.

Plus, there are solutions. Whether it’s tweaking medications, using swallowing therapy, or treating underlying inflammation, there’s hope. You don’t have to just “deal with it.”

Can Rheumatoid Arthritis Cause Difficulty Swallowing Over Time?

One thing I always tell my patients is that rheumatoid arthritis doesn’t always follow a straight line. Symptoms can ebb and flow, and sometimes they evolve in subtle ways. So yes — can rheumatoid arthritis cause difficulty swallowing over time? Absolutely. Especially in people who’ve had RA for many years or who’ve gone through periods of poorly controlled inflammation.

I had a patient, Mark, in his late 50s, who came in frustrated because he felt like his food would “pause” halfway down when he ate. We did some digging, and sure enough, chronic inflammation had led to esophageal motility issues. This isn’t uncommon. Over time, inflammation can lead to scarring or weakening in the muscles of the throat and esophagus, changing how they work.

Even mild, nagging symptoms like occasional coughing while drinking water can be a clue that something’s shifting. That’s why it’s so important to stay proactive — not just reactive — when it comes to your care plan.

How Swallowing Issues Can Impact Daily Life

Let’s talk quality of life for a second. Because let’s face it, we don’t often think about how essential swallowing is… until it starts to feel like a struggle. I’ve seen patients avoid going out to eat with friends because they’re embarrassed about coughing or taking forever to finish a meal. Others start skipping meals altogether — not because they’re not hungry, but because eating feels like work.

And the emotional toll? That’s real, too. As one of my patients put it, “It’s like my body is failing at the basics.” That kind of frustration can creep into your mental health, and RA already increases the risk for things like anxiety and depression.

Subtle Ways It Shows Up

Some folks don’t even realize their swallowing is off until they start describing it aloud during a check-in. Here are a few subtle red flags I ask about:

Do you feel like you’re chewing more than usual before swallowing?
Are you sipping more water during meals to help food go down?
Ever feel like there’s pressure in your chest after eating?
Do certain textures (like dry chicken or rice) give you trouble?

If you answered “yes” to any of those, it might be time to bring it up with your provider. I always say — if it’s interfering with how you enjoy food, it matters. Period.

What to Expect During Evaluation

When someone with RA starts having swallowing issues, we usually take a multi-pronged approach. I work closely with gastroenterologists and speech-language pathologists (SLPs) who specialize in swallowing disorders. Here’s what the process typically looks like:

Detailed History: We talk through symptoms, duration, and how they’ve changed over time.
Medication Review: Sometimes a med tweak is all it takes to ease things up.
Barium Swallow Study: This X-ray test shows us how food and liquid move through your throat and esophagus in real-time.
Endoscopy: If needed, a GI specialist might take a closer look inside with a scope — especially if we’re worried about inflammation, nodules, or strictures.

It’s not about throwing every test at you — it’s about piecing together your story to figure out the “why.” I find that most patients are relieved once we identify a cause. It shifts the focus from “what’s wrong with me?” to “what can we do about it?”

Speech Therapy Isn’t Just for Speech

One surprise for many folks is that SLPs don’t just help with speech — they’re swallowing pros, too. I’ve had patients work with an SLP for a few weeks and see major improvements. They might recommend simple exercises, posture changes, or even food texture adjustments that make a big difference at mealtime.

Plus, it feels empowering. Instead of just waiting for meds to kick in, you’re doing something active to support your body — and that mindset shift is huge in chronic illness management.

Managing Swallowing Challenges at Home

While you’re working with your care team, there’s a lot you can do day-to-day to make eating safer and more comfortable. Here are a few tips I often share with my patients:

Take smaller bites and chew thoroughly. Sounds simple, but it really helps.
Use gravity to your advantage. Sit fully upright while eating — no lounging!
Stay hydrated. Sips of water between bites can keep things moving smoothly.
Stick to moist, soft foods during flare-ups — things like soups, casseroles, or smoothies.
Keep a symptom journal. It helps us identify patterns and trigger foods.

Above all, listen to your body. If something feels off, don’t ignore it. The earlier we catch these complications, the easier they are to manage — and that means you get back to enjoying your meals (and your life) sooner.

Long-Term Treatment Strategies for RA-Related Swallowing Issues

Alright, now that we’ve dug into the *why* and *how* behind swallowing issues in RA, let’s talk about the long game. Because honestly, rheumatoid arthritis is a marathon — not a sprint — and managing symptoms like dysphagia (difficulty swallowing) requires some flexibility and a personalized approach.

First off, it’s critical that your RA itself is under control. That’s always the foundation. If inflammation is raging unchecked, even the best swallowing therapy or dietary changes can only do so much. I’ve seen this play out in my own practice. Once we adjusted a patient’s DMARDs (disease-modifying anti-rheumatic drugs) and brought their disease activity down, their swallowing symptoms also noticeably improved.

So, step one? Make sure your rheumatologist knows about the issue. It could mean tweaking your treatment — whether that’s adding a biologic, increasing your methotrexate dose, or evaluating side effects from corticosteroids.

Working With a Multi-Disciplinary Team

If there’s one thing I’ve learned over the years, it’s that the best outcomes happen when providers talk to each other. I love collaborating with ENT docs, SLPs, and GIs because everyone brings a different piece to the puzzle.

Rheumatologist: Controls the overall disease process
Speech-Language Pathologist: Offers therapy and techniques to improve swallow function
Gastroenterologist: Helps manage esophageal involvement, especially if strictures or reflux are factors
Dietitian: Keeps nutrition on track even if certain foods become hard to eat

In one case, I had a patient on high-dose steroids who developed severe reflux. That reflux irritated her esophagus so much that it made swallowing painful. Once we looped in GI and got her on a proper reflux regimen, her symptoms backed off. Just another reminder that in RA, things are rarely caused by a single factor — and rarely fixed by a single solution.

When to Reevaluate: Signs It’s Time for a Follow-Up

Living with RA means you get pretty good at tuning into your body. So if something starts to feel “off” — even subtly — it’s worth checking in. Here are a few signs I always tell my patients to watch for when it comes to swallowing:

Worsening hoarseness or voice changes
More frequent choking episodes
Increased difficulty swallowing pills
Weight loss or avoidance of meals
Feeling like food is stuck more often than before

If any of those pop up, don’t brush them off. Book that appointment, and advocate for the workup you deserve. And please — don’t let anyone tell you it’s “just aging” or “nothing to worry about.” You know your body better than anyone.

Living Well with RA and Swallowing Issues

Here’s the hopeful part — because yes, there is one. With the right care and the right team, most people can manage swallowing issues in RA without giving up the joy of eating or living fully.

I remember one patient, Claire, who came in convinced she’d have to stick to pureed foods forever. But with some SLP-guided exercises, a medication change, and simple tricks like sitting upright for 30 minutes after eating, she was back to enjoying dinner with her family — even steak night!

RA throws a lot your way. But every little improvement matters. Small victories like comfortably swallowing your meds or eating a sandwich without coughing are *big wins* in my book.

Everyday Tips I Share With My Own Patients

Warm liquids before meals can relax the esophageal muscles — tea or broth is perfect
Use a pill crusher (if safe) or ask your pharmacist about alternatives to large tablets
Stay upright for at least 30 minutes after meals
Keep a food and symptom journal — patterns often emerge!
Don’t skip meals — small, frequent ones are better than trying to “push through” one big one

Final Thoughts: Speak Up, Stay Empowered

So, to circle back — can rheumatoid arthritis cause difficulty swallowing? Yes, it can. But that doesn’t mean you have to just live with it in silence. This symptom, like every other part of RA, is manageable. You just need the right info, the right support, and a little bit of that fierce self-advocacy that every RA warrior eventually masters.

I hope this guide helps you feel a bit more seen, informed, and ready to take the next step — whatever that looks like for you.

Helpful Resources

Disclaimer

This article is for informational purposes only and is not intended to replace professional medical advice, diagnosis, or treatment. Always talk to your healthcare provider about any new or worsening symptoms.

Tarra Nugroho

Tarra Nugroho is a dedicated Nurse Practitioner with a strong foundation in family and preventive care. She brings both compassion and clinical expertise to her practice, focusing on patient-centered care and health education. As a contributor to Healthusias.com, Tarra translates medical knowledge into clear, empowering articles on topics like women’s health, chronic disease management, and lifestyle medicine. Her mission is simple: help people feel seen, heard, and informed—both in the clinic and through the content she creates. When she’s not caring for patients, Tarra enjoys weekend hikes, plant-based cooking, and curling up with a good health podcast.