Login Register Cart 0
Generic placeholder image

Current Rheumatology Reviews

Editor-in-Chief

ISSN (Print): 1573-3971
ISSN (Online): 1875-6360

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Systematic Review Article

Bronchoalveolar Lavage in Systemic Sclerosis Patients: A Systematic Review

Author(s): Sérgio Oliveira da Silva, Adriane Souza da Paz, Isla Miranda Vidal Cavalcante Farias, Damille Sandes Moreira, Marianna Alegro Fontes Ribeiro, Tatiana Senna Galvão Nonato Alves, Antônio Carlos Moreira Lemos and Mittermayer Barreto Santiago*

Volume 17, Issue 2, 2021

Published on: 13 November, 2020

Page: [176 - 183] Pages: 8

DOI: 10.2174/1573397116666201113091655

Price: $65

Abstract

Introduction: We performed a systematic review of the literature to determine the value of bronchoalveolar lavage (BAL) in evaluating the pulmonary involvement of systemic sclerosis (SSc).

Methods: Articles published between 1980 and 2019 were retrieved from the databases: PubMed and Scielo. The search was restricted to clinical trials published in English, utilizing the keywords “scleroderma, systemic sclerosis, interstitial lung disease, and bronchoalveolar lavage”.

Results: Twenty-two papers were analyzed. A positive correlation was observed between increased BAL cellularity (alveolitis) and worsening clinical symptoms, pulmonary function, and radiological pattern in 2, 11, and 15 studies, respectively. The majority of BAL studies that evaluated interleukin levels, including TNF-α, IL-6, IL-7, and IL-8, observed higher levels in patients with impaired pulmonary function and increased lung involvement.

Conclusions: Alveolitis and the increase of some cytokines/chemokines in BAL were related to more severe pulmonary disease in SSc in the majority of the studies and seemed to be markers of worse prognosis, but it is unknown whether BAL adds clinical value to the use of the other non-invasive diagnostic procedures.

Keywords: Systemic sclerosis, scleroderma, interstitial lung disease, Bronchoalveolar lavage, alveolitis, pulmonary disease.

« Previous Next »
Graphical Abstract

[1]
Lopes AJ, Capone D, Mogami R, Menezes SL, Guimarães FS, Levy RA. Systemic sclerosis-associated interstitial pneumonia: evaluation of pulmonary function over a five-year period. J Bras Pneumol 2011; 37(2): 144-51.
[http://dx.doi.org/10.1590/S1806-37132011000200003] [PMID: 21537649]
[2]
Solomon JJ, Olson AL, Fischer A, Bull T, Brown KK, Raghu G. Scleroderma lung disease. Eur Respir Rev 2013; 22(127): 6-19.
[http://dx.doi.org/10.1183/09059180.00005512] [PMID: 23457159]
[3]
Baldi BG, Pereira CA, Rubin AS, et al. Highlights of the Brazilian Thoracic Association guidelines for interstitial lung diseases. J Bras Pneumol 2012; 38(3): 282-91.
[http://dx.doi.org/10.1590/S1806-37132012000300002] [PMID: 22782597]
[4]
Goh NS, Desai SR, Veeraraghavan S, et al. Interstitial lung disease in systemic sclerosis: a simple staging system. Am J Respir Crit Care Med 2008; 177(11): 1248-54.
[http://dx.doi.org/10.1164/rccm.200706-877OC] [PMID: 18369202]
[5]
Kowal-Bielecka O, Kowal K, Highland KB, Silver RM. Bronchoalveolar lavage fluid in scleroderma interstitial lung disease: technical aspects and clinical correlations: review of the literature. Semin Arthritis Rheum 2010; 40(1): 73-88.
[http://dx.doi.org/10.1016/j.semarthrit.2008.10.009] [PMID: 19152959]
[6]
Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement. Open Med 2009; 3(3): e123-30.
[PMID: 21603045]
[7]
van den Hoogen F, Khanna D, Fransen J, et al. 2013 classification criteria for systemic sclerosis: an American college of rheumatology/European league against rheumatism collaborative initiative. Ann Rheum Dis 2013; 72(11): 1747-55.
[http://dx.doi.org/10.1136/annrheumdis-2013-204424] [PMID: 24092682]
[8]
Preliminary criteria for the classification of systemic sclerosis (scleroderma). Subcommittee for scleroderma criteria of the American Rheumatism Association Diagnostic and Therapeutic Criteria Committee. Arthritis Rheum 1980; 23(5): 581-90.
[http://dx.doi.org/10.1002/art.1780230510] [PMID: 7378088]
[9]
LeRoy EC, Black C, Fleischmajer R, et al. Scleroderma (systemic sclerosis): classification, subsets and pathogenesis. J Rheumatol 1988; 15(2): 202-5.
[PMID: 3361530]
[10]
Silver RM, Metcalf JF, Stanley JH, LeRoy EC. Interstitial lung disease in scleroderma. Analysis by bronchoalveolar lavage. Arthritis Rheum 1984; 27(11): 1254-62.
[http://dx.doi.org/10.1002/art.1780271107] [PMID: 6497920]
[11]
Kowal-Bielecka O, Kowal K, Rojewska J, et al. Cyclophosphamide reduces neutrophilic alveolitis in patients with scleroderma lung disease: a retrospective analysis of serial bronchoalveolar lavage investigations. Ann Rheum Dis 2005; 64(9): 1343-6.
[http://dx.doi.org/10.1136/ard.2004.033076] [PMID: 16100339]
[12]
Strange C, Bolster MB, Roth MD, et al. Scleroderma Lung Study Research Group. Bronchoalveolar lavage and response to cyclophosphamide in scleroderma interstitial lung disease. Am J Respir Crit Care Med 2008; 177(1): 91-8.
[http://dx.doi.org/10.1164/rccm.200705-655OC] [PMID: 17901414]
[13]
Witt C, Borges AC, John M, Fietze I, Baumann G, Krause A. Pulmonary involvement in diffuse cutaneous systemic sclerosis: broncheoalveolar fluid granulocytosis predicts progression of fibrosing alveolitis. Ann Rheum Dis 1999; 58(10): 635-40.
[http://dx.doi.org/10.1136/ard.58.10.635] [PMID: 10491363]
[14]
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.
[http://dx.doi.org/10.1002/art.22696] [PMID: 17530640]
[15]
Frigieri L, Mormile F, Grilli N, et al. Bilateral bronchoalveolar lavage in progressive systemic sclerosis: interlobar variability, lymphocyte subpopulations, and functional correlations. Respiration 1991; 58(3-4): 132-40.
[http://dx.doi.org/10.1159/000195913] [PMID: 1745844]
[16]
Silver RM, Miller KS, Kinsella MB, Smith EA, Schabel SI. Evaluation and management of scleroderma lung disease using bronchoalveolar lavage. Am J Med 1990; 88(5): 470-6.
[http://dx.doi.org/10.1016/0002-9343(90)90425-D] [PMID: 2337105]
[17]
Behr J, Vogelmeier C, Beinert T, et al. Bronchoalveolar lavage for evaluation and management of scleroderma disease of the lung. Am J Respir Crit Care Med 1996; 154(2 Pt 1): 400-6.
[http://dx.doi.org/10.1164/ajrccm.154.2.8756813] [PMID: 8756813]
[18]
De Santis M, Bosello S, La Torre G, et al. Functional, radiological and biological markers of alveolitis and infections of the lower respiratory tract in patients with systemic sclerosis. Respir Res 2005; 6: 96.
[http://dx.doi.org/10.1186/1465-9921-6-96] [PMID: 16107215]
[19]
Volpinari S, La Corte R, Bighi S, et al. Bronchoalveolar lavage in systemic sclerosis with lung involvement: role and correlations with functional, radiological and scintigraphic parameters. Rheumatol Int 2011; 31(9): 1183-8.
[http://dx.doi.org/10.1007/s00296-010-1390-9] [PMID: 20352228]
[20]
De Santis M, Bosello SL, Peluso G, et al. Bronchoalveolar lavage fluid and progression of scleroderma interstitial lung disease. Clin Respir J 2012; 6(1): 9-17.
[http://dx.doi.org/10.1111/j.1752-699X.2010.00228.x] [PMID: 21801327]
[21]
Clements PJ, Goldin JG, Kleerup EC, et al. Regional differences in bronchoalveolar lavage and thoracic high-resolution computed tomography results in dyspneic patients with systemic sclerosis. Arthritis Rheum 2004; 50(6): 1909-17.
[http://dx.doi.org/10.1002/art.20265] [PMID: 15188367]
[22]
Harrison NK, McAnulty RJ, Haslam PL, Black CM, Laurent GJ. Evidence for protein oedema, neutrophil influx, and enhanced collagen production in lungs of patients with systemic sclerosis. Thorax 1990; 45(8): 606-10.
[http://dx.doi.org/10.1136/thx.45.8.606] [PMID: 2402723]
[23]
Cakmak G, Selcuk Can T, Gundogdu S, et al. Relationship Between Abnormalities on High-Resolution Computerized Tomography, Pulmonary Function, and Bronchoalveolar Lavage in Progressive Systemic Sclerosis. Sarcoidosis Vasc Diffuse Lung Dis 2016; 33(4): 349-54.
[PMID: 28079847]
[24]
Gohari Moghadam K, Gharibdoost F, Parastandechehr G, Salehian P. Assessments of pulmonary involvement in patients with systemic sclerosis. Arch Iran Med 2011; 14(1): 22-6.
[PMID: 21194257]
[25]
Bolster MB, Ludwicka A, Sutherland SE, Strange C, Silver RM. Cytokine concentrations in bronchoalveolar lavage fluid of patients with systemic sclerosis. Arthritis Rheum 1997; 40(4): 743-51.
[http://dx.doi.org/10.1002/art.1780400422] [PMID: 9125259]
[26]
Hussein MR, Hassan HI, Hofny ER, et al. Alterations of mononuclear inflammatory cells, CD4/CD8+ T cells, interleukin 1beta, and tumour necrosis factor alpha in the bronchoalveolar lavage fluid, peripheral blood, and skin of patients with systemic sclerosis. J Clin Pathol 2005; 58(2): 178-84.
[http://dx.doi.org/10.1136/jcp.2004.019224] [PMID: 15677539]
[27]
Schmidt K, Martinez-Gamboa L, Meier S, et al. Bronchoalveoloar lavage fluid cytokines and chemokines as markers and predictors for the outcome of interstitial lung disease in systemic sclerosis patients. Arthritis Res Ther 2009; 11(4): R111.
[http://dx.doi.org/10.1186/ar2766] [PMID: 19615053]
[28]
Hesselstrand R, Wildt M, Bozovic G, et al. Biomarkers from bronchoalveolar lavage fluid in systemic sclerosis patients with interstitial lung disease relate to severity of lung fibrosis. Respir Med 2013; 107(7): 1079-86.
[http://dx.doi.org/10.1016/j.rmed.2013.03.015] [PMID: 23660398]
[29]
Sfriso P, Cozzi F, Oliviero F, et al. CXCL11 in bronchoalveolar lavage fluid and pulmonary function decline in systemic sclerosis. Clin Exp Rheumatol 2012; 30(2)(Suppl. 71): S71-5.
[PMID: 22691213]
[30]
Harrison NK, Glanville AR, Strickland B, et al. Pulmonary involvement in systemic sclerosis: the detection of early changes by thin section CT scan, bronchoalveolar lavage and 99mTc-DTPA clearance. Respir Med 1989; 83(5): 403-14.
[http://dx.doi.org/10.1016/S0954-6111(89)80072-1] [PMID: 2694236]
[31]
Wells AU, Hansell DM, Rubens MB, et al. Fibrosing alveolitis in systemic sclerosis. Bronchoalveolar lavage findings in relation to computed tomographic appearance. Am J Respir Crit Care Med 1994; 150(2): 462-8.
[http://dx.doi.org/10.1164/ajrccm.150.2.8049830] [PMID: 8049830]
[32]
Tamby MC, Chanseaud Y, Guillevin L, Mouthon L. New insights into the pathogenesis of systemic sclerosis. Autoimmun Rev. 2003;2(3):152-7. outcome of interstitial lung disease in systemic sclerosis patients. Arthritis Res Ther 2009; 11(4): R111.
[PMID: 19615053]
[33]
Vatrella A, Bocchino M, Perna F, et al. Induced sputum as a tool for early detection of airway inflammation in connective diseases-related lung involvement. Respir Med 2007; 101(7): 1383-9.
[http://dx.doi.org/10.1016/j.rmed.2007.02.003] [PMID: 17369033]
[34]
Yilmaz N, Abul Y, Bicakcigil M, et al. Induced sputum as a method for detection of systemic sclerosis-related interstitial lung disease. Rheumatol Int 2012; 32(7): 1921-5.
[http://dx.doi.org/10.1007/s00296-011-1872-4] [PMID: 21448645]
[35]
Litinsky I, Fireman E, Paran D, et al. Induced Sputum Analysis in Subjects With Systemic Sclerosis. Respir Care 2016; 61(10): 1369-73.
[http://dx.doi.org/10.4187/respcare.04706] [PMID: 27274093]

Rights & Permissions Print Cite
Article Metrics
32
© 2024 Bentham Science Publishers | Privacy Policy