title: Bronchoalveolar lavage fluid and progression of scleroderma interstitial lung disease.
abstract: BACKGROUND
  So far no clinical or experimental evidences clearly explain how and which systemic sclerosis (SSc) patients will experience a functional and radiological progression of interstitial lung disease (ILD).
  
  
  OBJECTIVE
  The aim of the study was to investigate whether any bronchoalveolar lavage fluid (BALF) characteristic, compared with clinical, functional and radiological parameters, is associated with the risk of progression of ILD and worse survival in SSc patients.
  
  
  METHODS
  Lung involvement was evaluated in 110 consecutively examined SSc patients with pulmonary function tests (PFTs) and high-resolution computed tomography (HRCT); 73 patients with evidence of ILD on HRCT underwent BAL. The progression of ILD was evaluated with PFTs and HRCT after 1-year follow-up. A 36-month survival analysis was assessed.
  
  
  RESULTS
  ILD patients with alveolitis had a higher risk to have restrictive lung disease and honeycombing, to experience a worsening in honeycombing score or to develop honeycombing. ILD progression was associated with the evidence of honeycombing on HRCT, with the presence of eosinophils, with an inverted CD4/CD8 ratio and with a higher CD19 percentage count in the BALF or with a positive BALF microbiological culture. The patients with ILD had a worse overall survival. The diffuse disease was the only independent risk factor of overall mortality, and the extent of honeycombing on HRCT was the only independent risk factor of lung disease-related mortality.
  
  
  CONCLUSIONS
  Our study suggests the importance of evaluating ILD with HRCT and BAL in order to characterize the risk factors of SSc lung involvement progression.
authors.affiliation: Department of Rheumatology, Catholic University, Rome, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: De Santis
authors.forename: Silvia Laura
authors.initials: SL
authors.lastname: Bosello
authors.forename: Giusy
authors.initials: G
authors.lastname: Peluso
authors.forename: Michela
authors.initials: M
authors.lastname: Pinnelli
authors.forename: Stefano
authors.initials: S
authors.lastname: Alivernini
authors.forename: Gaetano
authors.initials: G
authors.lastname: Zizzo
authors.forename: Mario
authors.initials: M
authors.lastname: Bocci
authors.forename: Annunziata
authors.initials: A
authors.lastname: Capacci
authors.forename: Giuseppe
authors.initials: G
authors.lastname: La Torre
authors.forename: Alice
authors.initials: A
authors.lastname: Mannocci
authors.forename: Gabriella
authors.initials: G
authors.lastname: Pagliari
authors.forename: Francesco
authors.initials: F
authors.lastname: Varone
authors.forename: Roberto
authors.initials: R
authors.lastname: Pistelli
authors.forename: Francesco Maria
authors.initials: FM
authors.lastname: Danza
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Ferraccioli
mesh_terms: D000906:Antibodies / Q000032:analysis; D000974:Antibodies, Antinuclear / Q000032:analysis; D018941:Antigens, CD19 / Q000378:metabolism; D001992:Bronchoalveolar Lavage Fluid / Q000166:cytology* / Q000382:microbiology*; D016516:CD4-CD8 Ratio; D026942:DNA Topoisomerases / Q000276:immunology; D018450:Disease Progression; D004804:Eosinophils / Q000378:metabolism; D005260:Female; D006801:Humans; D016015:Logistic Models; D008168:Lung / Q000000981:diagnostic imaging; D017563:Lung Diseases, Interstitial / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012595:Scleroderma, Systemic / Q000401:mortality*; D014057:Tomography, X-Ray Computed; D014797:Vital Capacity
chemical_list: D000906:Antibodies; D000974:Antibodies, Antinuclear; D018941:Antigens, CD19; C538950:anticentromere antibody; D026942:DNA Topoisomerases