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Bronchoalveolar lavage cellular profiles in patients with systemic sclerosis-associated interstitial lung disease are not predictive of disease progression.
Arthritis Rheum. 2007 Jun; 56(6):2005-12.AR

Abstract

OBJECTIVE

To evaluate the prognostic value of bronchoalveolar lavage (BAL) cellular profiles in patients with systemic sclerosis-associated interstitial lung disease (SSc-ILD).

METHODS

BAL cellularity was examined in relation to mortality (n = 141), serial pulmonary function findings (n = 134), and "progression-free survival" (n = 134), by proportional hazards analysis. Baseline severity was quantified according to the extent of disease on high-resolution computed tomography, the diffusing capacity for carbon monoxide, and the presence or absence of pulmonary hypertension. Mortality was subclassified into overall mortality (during 10 years of followup), early mortality (occurring within 2 years of presentation), and late mortality (occurring 2-10 years after presentation).

RESULTS

Overall mortality was associated with neutrophilia on BAL (hazard ratio 2.23 [95% confidence interval 1.20-4.14], P = 0.01), but this effect was lost when disease severity was taken into account. Early mortality was associated with neutrophilia on BAL (hazard ratio 8.40 [95% confidence interval 1.91-36.95], P = 0.005), independent of disease severity. Late mortality was not associated with neutrophilia on BAL. The presence of neutrophilia on BAL was not associated with time to decline in pulmonary function or progression-free survival. Neither eosinophilia nor lymphocytosis on BAL was associated with mortality, rapidity of functional deterioration, or progression-free survival. These findings were unaltered when treatment status was taken into account.

CONCLUSION

BAL findings provide only limited prognostic information in SSc-ILD. Neutrophilia on BAL is linked to early mortality, but BAL findings are not linked to long-term survival or the rapidity of progression of lung disease. The usefulness of BAL to define alveolitis in SSc is questionable.

Authors+Show Affiliations

Royal Brompton Hospital and National Heart and Lung Institute, London, UK.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17530640

Citation

Goh, Nicole S L., et al. "Bronchoalveolar Lavage Cellular Profiles in Patients With Systemic Sclerosis-associated Interstitial Lung Disease Are Not Predictive of Disease Progression." Arthritis and Rheumatism, vol. 56, no. 6, 2007, pp. 2005-12.
Goh NS, Veeraraghavan S, Desai SR, et al. Bronchoalveolar lavage cellular profiles in patients with systemic sclerosis-associated interstitial lung disease are not predictive of disease progression. Arthritis Rheum. 2007;56(6):2005-12.
Goh, N. S., Veeraraghavan, S., Desai, S. R., Cramer, D., Hansell, D. M., Denton, C. P., Black, C. M., du Bois, R. M., & Wells, A. U. (2007). Bronchoalveolar lavage cellular profiles in patients with systemic sclerosis-associated interstitial lung disease are not predictive of disease progression. Arthritis and Rheumatism, 56(6), 2005-12.
Goh NS, et al. Bronchoalveolar Lavage Cellular Profiles in Patients With Systemic Sclerosis-associated Interstitial Lung Disease Are Not Predictive of Disease Progression. Arthritis Rheum. 2007;56(6):2005-12. PubMed PMID: 17530640.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Bronchoalveolar lavage cellular profiles in patients with systemic sclerosis-associated interstitial lung disease are not predictive of disease progression. AU - Goh,Nicole S L, AU - Veeraraghavan,Srihari, AU - Desai,Sujal R, AU - Cramer,Derek, AU - Hansell,David M, AU - Denton,Christopher P, AU - Black,Carol M, AU - du Bois,Roland M, AU - Wells,Athol U, PY - 2007/5/29/pubmed PY - 2007/7/21/medline PY - 2007/5/29/entrez SP - 2005 EP - 12 JF - Arthritis and rheumatism JO - Arthritis Rheum VL - 56 IS - 6 N2 - OBJECTIVE: To evaluate the prognostic value of bronchoalveolar lavage (BAL) cellular profiles in patients with systemic sclerosis-associated interstitial lung disease (SSc-ILD). METHODS: BAL cellularity was examined in relation to mortality (n = 141), serial pulmonary function findings (n = 134), and "progression-free survival" (n = 134), by proportional hazards analysis. Baseline severity was quantified according to the extent of disease on high-resolution computed tomography, the diffusing capacity for carbon monoxide, and the presence or absence of pulmonary hypertension. Mortality was subclassified into overall mortality (during 10 years of followup), early mortality (occurring within 2 years of presentation), and late mortality (occurring 2-10 years after presentation). RESULTS: Overall mortality was associated with neutrophilia on BAL (hazard ratio 2.23 [95% confidence interval 1.20-4.14], P = 0.01), but this effect was lost when disease severity was taken into account. Early mortality was associated with neutrophilia on BAL (hazard ratio 8.40 [95% confidence interval 1.91-36.95], P = 0.005), independent of disease severity. Late mortality was not associated with neutrophilia on BAL. The presence of neutrophilia on BAL was not associated with time to decline in pulmonary function or progression-free survival. Neither eosinophilia nor lymphocytosis on BAL was associated with mortality, rapidity of functional deterioration, or progression-free survival. These findings were unaltered when treatment status was taken into account. CONCLUSION: BAL findings provide only limited prognostic information in SSc-ILD. Neutrophilia on BAL is linked to early mortality, but BAL findings are not linked to long-term survival or the rapidity of progression of lung disease. The usefulness of BAL to define alveolitis in SSc is questionable. SN - 0004-3591 UR - https://www.unboundmedicine.com/medline/citation/17530640/Bronchoalveolar_lavage_cellular_profiles_in_patients_with_systemic_sclerosis_associated_interstitial_lung_disease_are_not_predictive_of_disease_progression_ L2 - https://doi.org/10.1002/art.22696 DB - PRIME DP - Unbound Medicine ER -