Background It has recently been shown that the heat shock protein (HSP) is implicated in the pathogenesis of pulmonary fibrosis. The current trial was achieved to detect the relation of HSP-90 in usual interstitial pneumonia (UIP)-associated rheumatoid arthritis (RA). Results Sixty RA patients were studied. Their mean age was 49.63 ± 9.22 years with a mean disease duration of 7.5 (2–14) years. High-resolution computed tomography (HRCT) chest was performed on all patients. Thirty four (56.6%) patients had abnormal radiological findings in CT chest and 26 (43.3%) had normal CT chest findings. In patients with pulmonary involvement by HRCT, the most common abnormality found was small airway disease in 23 (38.3%), followed by UIP in nine (15%), and rheumatoid nodules in two (3.3%) patients. Patients with UIP pattern in HRCT chest has a significant higher level of HSP-90 level in comparison with those with RA-associated small airway disease pattern, P=0.003, and in comparison with other RA patients with no pulmonary involvement by HRCT, P=0.006. Conclusions HSP-90 was significantly elevated in UIP-associated RA and hence studying its inhibition in further studies would have a promising therapeutic role in this subset of patients.