The British Journal of Rheumatology, Vol 37, 263-269, Copyright © 1998 by British Society for Rheumatology
F Salaffi, P Manganelli, M Carotti, S Baldelli, P Blasetti, S Subiaco, MC Binci, E Bichi Secchi, F Amici and C Cervini
Eighteen non-smoking women suffering from primary Sjogren's syndrome (pSS)
with previously documented alveolitis were re-examined, clinically and by
pulmonary function tests (PFT), bronchoalveolar lavage (BAL), chest X-ray
and high-resolution computed tomography (HRCT) after a 2 yr follow-up
period. Longitudinal evaluation revealed unchanged PFT. The final BAL study
showed a normal differential count in six of 14 patients with initial
lymphocyte alveolitis, and a persistent alveolar lymphocytosis in the
remaining eight patients, associated with an increased percentage of
neutrophils in one of them. In four patients with initial mixed alveolitis,
the BAL cell profile was unchanged 2 yr later. Five of 18 patients (28%)
had abnormal HRCT, represented by isolated septal/subpleural lines in three
patients, ground-glass opacities with irregular pleural margins in one
patient, and ground-glass opacities associated with septal/subpleural lines
in another. All these patients had abnormal BAL results with an increased
proportion of both neutrophils and lymphocytes. The presence of alveolar
neutrophils was associated with a significantly (P=0.005) greater mean rate
of reduction of carbon monoxide diffusing capacity (DLCO) -- more than four
times the normal rate of loss of DLCO. Chest X- ray, repeated at the end of
the 2 yr follow-up period, showed parenchymal abnormalities in only one
patient who had evidence of fibrosis on HRCT. This study provides evidence
that lung involvement is not an uncommon extraglandular manifestation of
pSS and that a BAL neutrophilia may play an important role in the
pathogenesis of pulmonary disease in this autoimmune disorder.
ORIGINAL PAPERS
A longitudinal study of pulmonary involvement in primary Sjogren's syndrome: relationship between alveolitis and subsequent lung changes on high-resolution computed tomography
Clinica Reumatologica, Universita di Ancona, Jesi, Italy.
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