Presentation: Radiological and Functional Lung Indices Worsening in Scleroderma Patients: Relationship with Alveolitis and Low Respiratory Tract Infections (2007)

23 Radiological and Functional Lung Indices Worsening in Scleroderma Patients: Relationship with Alveolitis and Low Respiratory Tract Infections

PURPOSE. The aim of this work was to study the radiological and functional lung indices worsening in SSc patients with interstitial lung disease (ILD) on high resolution computed tomography (HRCT) with or without alveolitis on bronchoalveolar lavage (BAL), compared to SSc patients without ILD.
METHODS. 100 SSc patients underwent pulmonary function tests (PFTs) and lung HRCT. BAL was assessed in 80 SSc patients with signs of ILD on HRCT. Alveolitis was diagnosed in 33 (43.9%) patients when neutrophils were ≥3% and/or eosinophils were ≥2%; cultures revealed infection in 16 (23.9%) patients. All the patients underwent PFTs and lung HRCT after 14.8±5.9 months follow up; 14 patients with alveolitis were treated with azathioprine and 8 with cyclophosphamide; the patients with BAL culture positive were treated with antimicrobial agents for 6 weeks. A decreased forced vital capacity (FVC) and/or diffusing capacity for carbon monoxide (TLCO)>15% or an increased alveolar or interstitial score >2 points were considered clinically significant.
RESULTS. In patients with ILD a worsening in interstitial score was observed either in patients with alveolitis (p=0.035) or without (p=0.004) at follow up. The patients with infection of the lower respiratory tract showed a significant worsening in interstitial score (p=0.021) and FVC (p=0.005) at follow up. A worsening in HRCT scores was observed in 19 (57.6%: 3/8 treated with cyclophosphamide, 9/14 with azathioprine, 7/9 not treated; p=ns) of patients with alveolitis, 14 (41.2%) of patients without alveolitis and in 7 (43.8%) of patients with infection independently of alveolitis (p=ns). Antiscl70 (OR2.9(CIs1.0-9.1)) and bilateral honeycombing on HRCT (OR3.2(CIs1.06-10.0)) resulted significantly associated with HRCT scores worsening in patients with ILD. 10 (30.3%: 4/8 treated with cyclophosphamide, 2/14 with azathioprine, 4/9 not treated, p=ns) of patients with alveolitis, 10 (29.4%) of patients without alveolitis and 6 (37.5%) patients with infection of the lower respiratory tract showed a significant worsening in TLCO. Moreover eosinophil (p=0.025), lymphocyte count (p=0.013), CD4/CD82.5% (OR3.9(CIs1.1-15.0)) were significantly associated with TLCO worsening at follow up in patients with ILD. 10 (30.3%) of patients without ILD developed isolated ground glass (p=0.006) and 7 (21.2%) experienced a worsening in TLCO (p=ns vs ILD).
CONCLUSIONS. The SSc patients with ILD on HRCT showed alveolitis on BAL in less than 50% of cases, nevertheless about 50% of SSc patients with ILD presented a worsening of HRCT scores at follow up independently on the presence of alveolitis and of the received treatment, especially when BAL cultures resulted positive or in case of bilateral honeycombing on HRCT. Moreover lymphocytes, CD4/CD8 ratio and B cell percentage on BAL showed a significant association with TLCO worsening.

 M. De Santis, None; S. Bosello, None; G. Peluso, None; B. Tolusso, None; S. Alivernini, None; M. Pinnelli, None; G. Ferraccioli, None.