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. 1990 Aug;45(8):591–596. doi: 10.1136/thx.45.8.591

Bronchoalveolar lavage in patients with mild and severe rheumatoid lung disease.

D M Gilligan 1, C M O'Connor 1, K Ward 1, D Moloney 1, B Bresnihan 1, M X FitzGerald 1
PMCID: PMC462634  PMID: 2169654

Abstract

The reported prevalence of interstitial lung disease in patients with rheumatoid arthritis has varied from 10% to 50%, yet less than 5% of patients with arthritis develop severe fibrosing interstitial lung disease. This suggests that subclinical disease may not always presage progressive disease. Bronchoalveolar lavage fluid from patients with rheumatoid arthritis and either clinically evident interstitial lung disease or subclinical disease was examined for the presence of factors with a putative role in the development of interstitial fibrosis. Patients with subclinical disease were identified by prospective radiographic and lung function screening of 93 patients with rheumatoid arthritis. Fourteen patients were identified in this manner and an association between subclinical disease and smoking history was noted. Eleven patients with established interstitial lung disease had increased neutrophils (p less than 0.05), collagenase, and type III procollagen N terminal peptide levels (p less than 0.01) in the bronchoalveolar lavage fluid. Preliminary characterisation of the bronchoalveolar lavage collagenase suggested that it originated from neutrophils. Ten patients with subclinical interstitial lung disease underwent bronchoalveolar lavage. Of these, one had increased neutrophils and two had increased collagenase concentrations--abnormalities associated with advanced interstitial lung disease and a poor prognosis. These results suggest that in arthritis patients with evidence of subclinical pulmonary interstitial disease bronchoalveolar lavage might be useful in identifying those who may require careful monitoring in the hope that early treatment will prevent severe fibrosis.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bateman E. D., Turner-Warwick M., Haslam P. L., Adelmann-Grill B. C. Cryptogenic fibrosing alveolitis: prediction of fibrogenic activity from immunohistochemical studies of collagen types in lung biopsy specimens. Thorax. 1983 Feb;38(2):93–101. doi: 10.1136/thx.38.2.93. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Cantin A. M., Boileau R., Bégin R. Increased procollagen III aminoterminal peptide-related antigens and fibroblast growth signals in the lungs of patients with idiopathic pulmonary fibrosis. Am Rev Respir Dis. 1988 Mar;137(3):572–578. doi: 10.1164/ajrccm/137.3.572. [DOI] [PubMed] [Google Scholar]
  3. Crystal R. G., Gadek J. E., Ferrans V. J., Fulmer J. D., Line B. R., Hunninghake G. W. Interstitial lung disease: current concepts of pathogenesis, staging and therapy. Am J Med. 1981 Mar;70(3):542–568. doi: 10.1016/0002-9343(81)90577-5. [DOI] [PubMed] [Google Scholar]
  4. Frank S. T., Weg J. G., Harkleroad L. E., Fitch R. F. Pulmonary dysfunction in rheumatoid disease. Chest. 1973 Jan;63(1):27–34. doi: 10.1378/chest.63.1.27. [DOI] [PubMed] [Google Scholar]
  5. Gadek J. E., Kelman J. A., Fells G., Weinberger S. E., Horwitz A. L., Reynolds H. Y., Fulmer J. D., Crystal R. G. Collagenase in the lower respiratory tract of patients with idiopathic pulmonary fibrosis. N Engl J Med. 1979 Oct 4;301(14):737–742. doi: 10.1056/NEJM197910043011401. [DOI] [PubMed] [Google Scholar]
  6. Garcia J. G., James H. L., Zinkgraf S., Perlman M. B., Keogh B. A. Lower respiratory tract abnormalities in rheumatoid interstitial lung disease. Potential role of neutrophils in lung injury. Am Rev Respir Dis. 1987 Oct;136(4):811–817. doi: 10.1164/ajrccm/136.4.811. [DOI] [PubMed] [Google Scholar]
  7. Garcia J. G., Parhami N., Killam D., Garcia P. L., Keogh B. A. Bronchoalveolar lavage fluid evaluation in rheumatoid arthritis. Am Rev Respir Dis. 1986 Mar;133(3):450–454. doi: 10.1164/arrd.1986.133.3.450. [DOI] [PubMed] [Google Scholar]
  8. Hakala M., Ruuska P., Hämeenkorpi R., Tiilikainen A., Ilonen J., Mäkitalo R. Diffuse interstitial lung disease in rheumatoid arthritis. Views on immunological and HLA findings. Scand J Rheumatol. 1986;15(4):368–376. doi: 10.3109/03009748609098205. [DOI] [PubMed] [Google Scholar]
  9. Haslam P. L., Turton C. W., Heard B., Lukoszek A., Collins J. V., Salsbury A. J., Turner-Warwick M. Bronchoalveolar lavage in pulmonary fibrosis: comparison of cells obtained with lung biopsy and clinical features. Thorax. 1980 Jan;35(1):9–18. doi: 10.1136/thx.35.1.9. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Horwitz A. L., Hance A. J., Crystal R. G. Granulocyte collagenase: selective digestion of type I relative to type III collagen. Proc Natl Acad Sci U S A. 1977 Mar;74(3):897–901. doi: 10.1073/pnas.74.3.897. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Hunninghake G. W., Fauci A. S. Pulmonary involvement in the collagen vascular diseases. Am Rev Respir Dis. 1979 Mar;119(3):471–503. doi: 10.1164/arrd.1979.119.3.471. [DOI] [PubMed] [Google Scholar]
  12. Hyland R. H., Gordon D. A., Broder I., Davies G. M., Russell M. L., Hutcheon M. A., Reid G. D., Cox D. W., Corey P. N., Mintz S. A systematic controlled study of pulmonary abnormalities in rheumatoid arthritis. J Rheumatol. 1983 Jun;10(3):395–405. [PubMed] [Google Scholar]
  13. KLINE N. S. PRIMER ON THE RHEUMATIC DISEASES. IV. JAMA. 1964 Nov 23;190:741–751. doi: 10.1001/jama.1964.03070210047009. [DOI] [PubMed] [Google Scholar]
  14. Low R. B., Cutroneo K. R., Davis G. S., Giancola M. S. Lavage type III procollagen N-terminal peptides in human pulmonary fibrosis and sarcoidosis. Lab Invest. 1983 Jun;48(6):755–759. [PubMed] [Google Scholar]
  15. O'Connor C., Odlum C., Van Breda A., Power C., Fitzgerald M. X. Collagenase and fibronectin in bronchoalveolar lavage fluid in patients with sarcoidosis. Thorax. 1988 May;43(5):393–400. doi: 10.1136/thx.43.5.393. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. O'Connor C., Ward K., van Breda A., McIlgorm A., FitzGerald M. X. Type 3 procollagen peptide in bronchoalveolar lavage fluid. Poor indicator of course and prognosis in sarcoidosis. Chest. 1989 Aug;96(2):339–344. doi: 10.1378/chest.96.2.339. [DOI] [PubMed] [Google Scholar]
  17. Peterson M. W., Monick M., Hunninghake G. W. Prognostic role of eosinophils in pulmonary fibrosis. Chest. 1987 Jul;92(1):51–56. doi: 10.1378/chest.92.1.51. [DOI] [PubMed] [Google Scholar]
  18. Popper M. S., Bogdonoff M. L., Hughes R. L. Interstitial rheumatoid lung disease. A reassessment and review of the literature. Chest. 1972 Sep;62(3):243–250. doi: 10.1378/chest.62.3.243. [DOI] [PubMed] [Google Scholar]
  19. Reynolds H. Y. Bronchoalveolar lavage. Am Rev Respir Dis. 1987 Jan;135(1):250–263. doi: 10.1164/arrd.1987.135.1.250. [DOI] [PubMed] [Google Scholar]
  20. Rudd R. M., Haslam P. L., Turner-Warwick M. Cryptogenic fibrosing alveolitis. Relationships of pulmonary physiology and bronchoalveolar lavage to response to treatment and prognosis. Am Rev Respir Dis. 1981 Jul;124(1):1–8. doi: 10.1164/arrd.1981.124.1.1. [DOI] [PubMed] [Google Scholar]
  21. Tishler M., Grief J., Fireman E., Yaron M., Topilsky M. Bronchoalveolar lavage--a sensitive tool for early diagnosis of pulmonary involvement in rheumatoid arthritis. J Rheumatol. 1986 Jun;13(3):547–550. [PubMed] [Google Scholar]
  22. Turner-Warwick M., Haslam P. L. The value of serial bronchoalveolar lavages in assessing the clinical progress of patients with cryptogenic fibrosing alveolitis. Am Rev Respir Dis. 1987 Jan;135(1):26–34. doi: 10.1164/arrd.1987.135.1.26. [DOI] [PubMed] [Google Scholar]
  23. Wallaert B., Hatron P. Y., Grosbois J. M., Tonnel A. B., Devulder B., Voisin C. Subclinical pulmonary involvement in collagen-vascular diseases assessed by bronchoalveolar lavage. Relationship between alveolitis and subsequent changes in lung function. Am Rev Respir Dis. 1986 Apr;133(4):574–580. doi: 10.1164/arrd.1986.133.4.574. [DOI] [PubMed] [Google Scholar]
  24. Weiland J. E., Garcia J. G., Davis W. B., Gadek J. E. Neutrophil collagenase in rheumatoid interstitial lung disease. J Appl Physiol (1985) 1987 Feb;62(2):628–633. doi: 10.1152/jappl.1987.62.2.628. [DOI] [PubMed] [Google Scholar]

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