Background: Rheumatoid arthritis patients often experience complications in their lungs, such as rheumatoid nodules, interstitial lung disease (RA-ILD), obstructive lung disease, bronchiectasis, obliterative bronchiolitis, drug-induced lung toxicity, and opportunistic infections due to immunosuppression. Since ILD plays such a crucial role in the natural history of RA, the role of methotrexate (MTX) as a DMARD for RA-ILD is hotly contested. Objectives: was to determine whether or not Methotrexate improves lung function in people with interstitial lung disease caused by rheumatoid arthritis. Patients and Methods: Fifty patients with RA and ILD were recruited from the outpatient clinic and inpatient units of the Physical Medicine, Rheumatology, and Rehabilitation Departments at Qena University Hospitals for this prospective hospital-based study. A complete history and physical examination were performed for all participants. The data collected included vital signs, complete cardio-pulmonary assessment, the related laboratory investigations and HRCT before and after treatment. Results: The mean age of the study population was 48 years, with a female: male ratio of around 7:1, two thirds were from rural areas, while the other third were from urban ones. Envirnmental exposure of materials blamed to have a relation with ILD development was found in 42% of the cases, and smoking in 5 cases (10%), with 30% had family history of RA only, 10% had family history of ILD only and another 10% had positive family history of both RA and ILD. the mean disease duration was 5.8 years. we found that majority of the cases showed improvement of arthritis on MTX without combination with another DMARD or biologics (94%). The majority of the cases showed ILD improvement (74%). but, 14% of the cases did not improve and only 6 cases (12%) showed deteriorated ILD after MTX , with P value = 0.137. Conclusion: Methotrexate showed a noticeable improvement of the RA associated ILD which can be attributed to the overall improvement of the disease.