title: Subclinical alveolar inflammation in rheumatoid arthritis: superoxide anion, neutrophil chemotactic activity and fibronectin generation by alveolar macrophages.
abstract: Interstitial lung disease (ILD) can be detected by pulmonary function testing (PFT) in 30-40% of rheumatoid arthritis (RA) patients. We assessed by bronchoalveolar lavage (BAL) the patterns of alveolitis in 21 RA patients: group 1 comprised 12 patients without evidence of ILD, and group 29 patients with clinical ILD defined by abnormal pulmonary function tests and/or chest X-ray. Cellular characteristics of BAL were studied in both groups. In addition, alveolar macrophages (AM) from patients in group 1 were isolated, and three parameters of cellular activation were studied: superoxide anion, fibronectin and neutrophil chemotactic activity generation. Total cell counts were not increased in group 1 but significantly increased in group 2 compared to controls. In group 1, 5/12 patients had elevated lymphocyte percentage (greater than 18%) suggesting subclinical lymphocyte alveolitis. In contrast, neutrophil alveolitis (greater than 4%) was found in 7/9 patients in group 2, mean percentage 12.9 +/- 4.2, compared with 1.2 +/- 6.4% in controls and 1.9 +/- 0.5% in group 1. These changes were not correlated with disease duration nor rheumatoid factor titres. Marked elevation of lymphocyte percentage was observed in patients with abnormal serum beta-2-microglobulin. Alveolar macrophages from group 1 patients released increased amounts of superoxide anion (7260 +/- 2700 vs controls 850 +/- 120 URL/5.10(5) cells), neutrophil chemotactic activity (21 +/- 4.8 vs controls 8.1 +/- 0.7 cells/HPF), and fibronectin (6.1 +/- 1.6 vs controls 1.3 +/- 0.2 ng.10(6) cells/hour). Whether or not lymphocyte alveolitis and/or AM dysfunction are pathogenic mechanisms of subsequent interstitial lung disease in patients who are still free of symptoms remains to be determined.
authors.affiliation: Département de Pneumologie, Hôpital A. Calmette et Institut Pasteur, Lille, France.
authors.forename: T
authors.initials: T
authors.lastname: Perez
authors.forename: J M
authors.initials: JM
authors.lastname: Farre
authors.forename: P
authors.initials: P
authors.lastname: Gosset
authors.forename: B
authors.initials: B
authors.lastname: Wallaert
authors.forename: B
authors.initials: B
authors.lastname: Duquesnoy
authors.forename: C
authors.initials: C
authors.lastname: Voisin
authors.forename: B
authors.initials: B
authors.lastname: Delcambre
authors.forename: A B
authors.initials: AB
authors.lastname: Tonnel
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000503:physiopathology*; D001992:Bronchoalveolar Lavage Fluid / Q000150:complications / Q000503:physiopathology*; D002634:Chemotaxis, Leukocyte; D005260:Female; D005353:Fibronectins / Q000378:metabolism; D006801:Humans; D008264:Macrophages / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000378:metabolism; D011650:Pulmonary Alveoli / Q000503:physiopathology*; D011658:Pulmonary Fibrosis / Q000150:complications / Q000503:physiopathology*; D013481:Superoxides / Q000378:metabolism
chemical_list: D005353:Fibronectins; D013481:Superoxides