Abstract
Bronchoalveolar lavage (BAL) was performed to investigate pulmonary involvement in 39 patients with rheumatoid arthritis (RA) and in 7 patients with RA and secondary Sjögren’s syndrome, and compared to 12 healthy controls. Lymphocytosis (more than 15%) was seen in 25, and more than 3% neutrophil granulocytes in 8 of 39 patients with RA. Lymphocytosis and/or neutrophil granulocytosis was seen in both seropositive and seronegative patients irrespective of clinical or radiologic findings. Patients with RA with or without secondary Sjögren’s syndrome had increased DR + lymphocytes in BAL compared with peripheral blood. In 7 patients with secondary Sjögren’s syndrome an increased helper/suppressor cell index (OKT4 + / OKT8+: 7.65 ± 2.10) and increased natural killer cells (OKNK +: 27.3 ± 5.5%) were found, as compared to 39 other patients with RA (OKT4+ / OKT8+: 2.16 ± 0.33, p<0.05; OKNK+: 14.5 ± 2.3%, p<0.05).
These BAL data are further evidence of frequent subclinical interstitial pulmonary involvement in RA with differences in the active autoimmune process from those in secondary Sjögren’s syndrome.
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Armstrong JG, Steele RH (1982) Localised pulmonary arteritis in rheumatoid disease. Thorax 37:313–314
Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, Healey LA, Kaplan SR, Liang MH, Luthra HS, Medsger TA, Mitchell DM, Neustadt DH, Pinals RS, Schaller JG, Sharp JT, Wilder RL, Hunder GG (1988) The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31:315–324
Balbi B, Cosulich E, Risso A, Sacco O, Balzano E, Rossi GA (1987) The interstitial lung disease associated with rheumatoid arthritis: evidence for imbalance of helper T-lymphocyte subpopulations at sites of disease activity. Bull Eur Physiopathol Respir 23:241–247
Brannan HM, Good CA, Divertie MB, Baggenstoss AH (1964) Pulmonary disease associated with rheumatoid arthritis. JAMA 189:914–918
Burmester GR, Kalden JR, Peter HH, Schedel I, Beck P, Wittenborg A (1978) Immunological and functional characteristics of peripheral blood and synovial fluid lymphocytes from patients with rheumatoid arthritis. Scand J Immunol 7:405–417
Burmester GR, Jahn B, Gramatzki M, Kalden JR (1983) Analysis of rheumatoid synovial T cells expressing the receptor for Interleukin-2 (Il-2) and/or the Ia antigens: different phenotypic expression as compared to in vitro activated T cells. Scand J Rheumatol suppl. 49:31
Caplan A (1953) Certain unusual radiological appearances in the chest of coal-miners suffering from rheumatoid arthritis. Thorax 8:29–37
Carter SD, Bacon PA, Hall ND (1981) Characterisation of activated lymphocytes in the peripheral blood of patients with rheumatoid arthritis. Ann Rheum Dis 40:293–298
Ceuppens JL, Goodwin JS, Searles RP (1981) The presence of la antigen on human peripheral blood T cells and T-cell subsets: analysis with monoclonal antibodies and the fluorescence-activated cell sorter. Cell Immunol 64:277–292
Costabel U, Bross KJ, Rühle KH, Löhr GW, Matthys H (1985) Ia-linked antigens on T-cells and their subpopulations in pulmonary sarcoidosis and in hypersensitivity pneumonitis. Analysis of bronchoalveolar and blood lymphocytes. Am Rev Respir Dis 131:337–342
Crisp AJ, Armstrong RD, Grahame R, Dussek JE (1982) Rheumatoid lung disease, pneumothorax, and eosinophilia. Ann Rheum Dis 41:137–140
Crystal RG (1982) Alveolitis: the key to the interstitial lung disorders. Thorax 37:1–10
Dalavanga YA, Drosos AA, Moutsopoulos HM (1986) Labial salivary gland immunopathology in Sjögren’s syndrome. Scand J Rheumatol 61 suppl:67–70
Delacroix DL, Marchandise FX, Francis C, Sibille Y (1985) Alpha-2-macroglobulin, monomeric and polymeric immunoglobulin A, and immunoglobulin M in bronchoalveolar lavage. Am Rev Respir Dis 132:829–835
Ellmann P, Ball RE (1948) “Rheumatoid disease” with joint and pulmonary manifestations. Br Med J 2:816–820
Ellman P, Cudkowicz L (1954) Pulmonary manifestations in the diffuse collagen diseases. Thorax 9:46–57
Fox RI, Carstens SA, Fong S, Robinson CA, Howell F, Vaughan JH (1982) Use of monoclonal antibodies to analyze peripheral blood and salivary gland lymphocyte subsets in Sjögren’s syndrome. Arthritis Rheum 25:419–427
Fox RI, Fong S, Sabharwal N, Carstens SA, Kung PC, Vaughan JH (1982) Synovial fluid lymphocytes differ from peripheral blood lymphocytes in patients with rheumatoid arthritis. J Immunol 128:351–354
Frank ST, Weg JG, Harkleroad LE, Fitch RF (1973) Pulmonary dysfunction in rheumatoid disease. Chest 63:27–34
Garcia JG, Parhami N, Khanijo V, Garcia P, Keogh BA (1984) Bronchoalveolar lavage of the lower respiratory tract in rheumatoid arthritis. Chest 86:300A
Garcia JGN, Parhami N, Killam D, Garcia PL, Keogh BA (1986) Bronchoalveolar lavage fluid evaluation in rheumatoid arthritis. Am Rev Respir Dis 133:450–454
Godard P, Clot J, Jonquet O, Bousquet J, Michel FB (1981) Lymphocyte subpopulations in bronchoalveolar lavages of patients with sarcoidosis and hypersensitivity pneumonitis. Chest 80:447–452
Herzog CA, Miller RR, Hoidal JR (1981) Bronchiolitis and rheumatoid arthritis. Am Rev Respir Dis 124:636–639
Hoffmann RA, Kung PC, Hansen WP, Goldstein P (1980) Simple and rapid measurement of human T-lymphocytes and their subclasses in peripheral blood. Proc Natl Acad Sci USA 77:4914–4917
Hunninghake GK, Fauci AS (1979) Pulmonary involvement in the collagen vascular diseases. Am Rev Respir Dis 119:471–450
Hatron PY, Wallaert B, Gosset D, Tonnel AB, Gosselin B, Voisin C, Devulder B (1987) Subclinical lung inflammation in primary Sjögren’s syndrome. Arthritis Rheum 30:1226–1231
Janossy G, Duke O, Poulter LW, Panayi G, Bofill M, Goldstein G (1981) Rheumatoid arthritis: a disease of T-lymphocyte/macrophage immunoregulation. Lancet 1:839–842
Koch B, Locher P, Burmester GR, Mohr W, Kalden JR (1984) The tissue architecture of synovial membranes in inflammatory and noninflammatory joint diseases. II. The localization of mononuclear cells as detected by monoclonal antibodies directed against T-lymphocyte subsets and natural killer cells. Rheumatol Int 4:79–85
Lasky HP, Bauer K, Pope RM (1988) Increased helper inducer and decreased suppressor inducer phenotypes in the rheumatoid joint. Arthritis Rheum 31:52–59
Martel W, Abell MR, Mikkelsen WM, Whitehouse WM (1968) Pulmonary and pleural lesions in rheumatoid disease. Radiology 90:641–653
Minato N, Takeda A, Kano S, Takaku F (1982) Studies of the function of natural killer-interferon system in patients with Sjögren’s syndrome. J Clin Invest 69:581–588
Miyasaka N, Seaman W, Bakshi A, Sauvezie B, Strand V, Pope R, Talal N (1983) Natural killing activity in Sjögren’s syndrome. Arthritis Rheum 26:954–960
Paradis IL, Dauber JH, Rabin BS (1986) Lymphocyte phenotypes in bronchoalveolar lavage and lung tissue in sarcoidosis and idiopathic pulmonary fibrosis. Am Rev Respir Dis 133:855–850
Patterson CD, Harville WE, Pierce JA. Rheumatoid lung disease. Ann Intern Med 62:685–697
Pedersen BK, Oxholm P (1988) Impaired release of natural killer cytotoxic factor in patients with primary Sjögren’s syndrome. Clin Exp Immunol 72:299–302
Petty TL, Wilkins M (1966) The five manifestations of rheumatoid lung. Chest 49:75–82
Popp W, Braun O, Zwick H, Rauscher H, Ritschka L (1989) Increased expression of HLA-DR antigen on alveolar macrophages in pulmonary diseases. Virchows Arch Pathol Anat 414:393–397
Popper MS, Bogdonoff ML, Hughes RL (1972) Interstitial rheumatoid lung diseases. A reassessment and review of the literature. Chest 62:243–249
Reinherz EL, Morimoto C, Penta AC, Schlossmann SF (1981) Subpopulations of the T4+ inducer T cell subsets in man: evidence for an amplifier population preferentially expressing Ia antigen upon activation. J Immunol 126:67–72
Reynolds HY (1987) Bronchoalveolar lavage. Am Rev Respir Dis 135:250–263
Sachs L (1984) Angewandte Statistik, 6th ed. Berlin: Springer Verlag
Sharp JT, Calkins E, Cohen AS, Schubart AF, Culabro JJ (1964) Observation on the clinical, chemical, and serological manifestation of rheumatoid arthritis, based on the course of 154 cases. Medicine 43:41–58
Spencer H (1985) Pathology of the Lung, Vol. 2, 4th ed. Oxford: Pergamon Press, pp. 807–814
Strimlan CV, Rosenow EC, Divertie MB, Harrison EG (1976) Pulmonary manifestations of Sjögren’s syndrome. Chest 70:354–361
Strumpf IJ, Feld MK, Cornelius MJ, Keogh BA, Crystal RG (1981) Safty of fiberoptic bronchoalveolar lavage in evaluation of interstitial lung disease. Chest 80:268–271
Talbott JA, Calkins E (1964) Pulmonary involvement in rheumatoid arthritis. JAMA 189:911–913
Thomas PD, Hunninghake GW (1987) Current concepts of the pathogenesis of sarcoidosis. Am Rev Respir Dis 135:747–760
Tishler M, Greif J, Fireman E, Yaron M, Topilsky M (1986) Bronchoalveolar lavage—a sensitive tool for early diagnosis of pulmonary involvement in rheumatoid arthritis. J Rheumatol 13:547–550
Turner-Warwick M, Haslam PL (1987) The value of serial bronchoalveolar lavages in assessing the clinical progress of patients with cryptogenic fibrosing alveolitis. Am Rev Respir Dis 135:26–34
Veys EM, Hermanns P, Verbruggen G, Schindler J, Goldstein G (1982) T lymphocytes in blood and synovial fluid in rheumatoid arthritis. Lancet 1:225–226
Walker WC, Wright V (1968) Pulmonary lesions and rheumatoid arthritis. Medicine 47:501–520
Walker WC, Wright V (1969) Diffuse interstitial pulmonary fibrosis and rheumatoid arthritis. Ann Rheum Dis 28:252–259
Wallaert B, Harton PY, Grosbois JM, Tonnel AB, Devulder B, Voisin C (1986) Subclinical pulmonary involvement in collagen vascular diseases assessed by bronchoalveolar lavage. Am Rev Respir Dis 133:574–580
Wallaert B, Prin L, Hatron PY, Ramon P, Tonnel AB, Voisin C (1987) Lymphocyte subpopulations in bronchoalveolar lavage in Sjögren’s syndrome. Evidence for an expansion of cytotoxic/suppressor subset in patients with alveolar neutrophilia. Chest 92:1025–1031
Yousem SA, Colby TV, Carrington CB (1985) Lung biopsy in rheumatoid arthritis. Am Rev Respir Dis 131:770–777
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Popp, W., Ritschka, L., Scherak, O. et al. Bronchoalveolar lavage in rheumatoid arthritis and secondary sjögren’s syndrome. Lung 168, 221–231 (1990). https://doi.org/10.1007/BF02719696
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DOI: https://doi.org/10.1007/BF02719696