, Volume 168, Issue 1, pp 221–231 | Cite as

Bronchoalveolar lavage in rheumatoid arthritis and secondary sjögren’s syndrome

  • Wolfgang Popp
  • Leopold Ritschka
  • Othmar Scherak
  • Otto Braun
  • Gernot Kolarz
  • Helmuth Rauscher
  • Hartmut Zwick


Bronchoalveolar lavage (BAL) was performed to investigate pulmonary involvement in 39 patients with rheumatoid arthritis (RA) and in 7 patients with RA and secondary Sjögren’s syndrome, and compared to 12 healthy controls. Lymphocytosis (more than 15%) was seen in 25, and more than 3% neutrophil granulocytes in 8 of 39 patients with RA. Lymphocytosis and/or neutrophil granulocytosis was seen in both seropositive and seronegative patients irrespective of clinical or radiologic findings. Patients with RA with or without secondary Sjögren’s syndrome had increased DR + lymphocytes in BAL compared with peripheral blood. In 7 patients with secondary Sjögren’s syndrome an increased helper/suppressor cell index (OKT4 + / OKT8+: 7.65 ± 2.10) and increased natural killer cells (OKNK +: 27.3 ± 5.5%) were found, as compared to 39 other patients with RA (OKT4+ / OKT8+: 2.16 ± 0.33, p<0.05; OKNK+: 14.5 ± 2.3%, p<0.05).

These BAL data are further evidence of frequent subclinical interstitial pulmonary involvement in RA with differences in the active autoimmune process from those in secondary Sjögren’s syndrome.

Key words

Bronchoalveolar lavage Rheumatoid arthritis Sjögren’s syndrome 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Armstrong JG, Steele RH (1982) Localised pulmonary arteritis in rheumatoid disease. Thorax 37:313–314PubMedCrossRefGoogle Scholar
  2. 2.
    Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, Healey LA, Kaplan SR, Liang MH, Luthra HS, Medsger TA, Mitchell DM, Neustadt DH, Pinals RS, Schaller JG, Sharp JT, Wilder RL, Hunder GG (1988) The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31:315–324PubMedCrossRefGoogle Scholar
  3. 3.
    Balbi B, Cosulich E, Risso A, Sacco O, Balzano E, Rossi GA (1987) The interstitial lung disease associated with rheumatoid arthritis: evidence for imbalance of helper T-lymphocyte subpopulations at sites of disease activity. Bull Eur Physiopathol Respir 23:241–247PubMedGoogle Scholar
  4. 4.
    Brannan HM, Good CA, Divertie MB, Baggenstoss AH (1964) Pulmonary disease associated with rheumatoid arthritis. JAMA 189:914–918PubMedGoogle Scholar
  5. 5.
    Burmester GR, Kalden JR, Peter HH, Schedel I, Beck P, Wittenborg A (1978) Immunological and functional characteristics of peripheral blood and synovial fluid lymphocytes from patients with rheumatoid arthritis. Scand J Immunol 7:405–417PubMedCrossRefGoogle Scholar
  6. 6.
    Burmester GR, Jahn B, Gramatzki M, Kalden JR (1983) Analysis of rheumatoid synovial T cells expressing the receptor for Interleukin-2 (Il-2) and/or the Ia antigens: different phenotypic expression as compared to in vitro activated T cells. Scand J Rheumatol suppl. 49:31Google Scholar
  7. 7.
    Caplan A (1953) Certain unusual radiological appearances in the chest of coal-miners suffering from rheumatoid arthritis. Thorax 8:29–37PubMedCrossRefGoogle Scholar
  8. 8.
    Carter SD, Bacon PA, Hall ND (1981) Characterisation of activated lymphocytes in the peripheral blood of patients with rheumatoid arthritis. Ann Rheum Dis 40:293–298PubMedCrossRefGoogle Scholar
  9. 9.
    Ceuppens JL, Goodwin JS, Searles RP (1981) The presence of la antigen on human peripheral blood T cells and T-cell subsets: analysis with monoclonal antibodies and the fluorescence-activated cell sorter. Cell Immunol 64:277–292PubMedCrossRefGoogle Scholar
  10. 10.
    Costabel U, Bross KJ, Rühle KH, Löhr GW, Matthys H (1985) Ia-linked antigens on T-cells and their subpopulations in pulmonary sarcoidosis and in hypersensitivity pneumonitis. Analysis of bronchoalveolar and blood lymphocytes. Am Rev Respir Dis 131:337–342PubMedGoogle Scholar
  11. 11.
    Crisp AJ, Armstrong RD, Grahame R, Dussek JE (1982) Rheumatoid lung disease, pneumothorax, and eosinophilia. Ann Rheum Dis 41:137–140PubMedCrossRefGoogle Scholar
  12. 12.
    Crystal RG (1982) Alveolitis: the key to the interstitial lung disorders. Thorax 37:1–10PubMedCrossRefGoogle Scholar
  13. 13.
    Dalavanga YA, Drosos AA, Moutsopoulos HM (1986) Labial salivary gland immunopathology in Sjögren’s syndrome. Scand J Rheumatol 61 suppl:67–70Google Scholar
  14. 14.
    Delacroix DL, Marchandise FX, Francis C, Sibille Y (1985) Alpha-2-macroglobulin, monomeric and polymeric immunoglobulin A, and immunoglobulin M in bronchoalveolar lavage. Am Rev Respir Dis 132:829–835PubMedGoogle Scholar
  15. 15.
    Ellmann P, Ball RE (1948) “Rheumatoid disease” with joint and pulmonary manifestations. Br Med J 2:816–820CrossRefGoogle Scholar
  16. 16.
    Ellman P, Cudkowicz L (1954) Pulmonary manifestations in the diffuse collagen diseases. Thorax 9:46–57PubMedCrossRefGoogle Scholar
  17. 17.
    Fox RI, Carstens SA, Fong S, Robinson CA, Howell F, Vaughan JH (1982) Use of monoclonal antibodies to analyze peripheral blood and salivary gland lymphocyte subsets in Sjögren’s syndrome. Arthritis Rheum 25:419–427PubMedCrossRefGoogle Scholar
  18. 18.
    Fox RI, Fong S, Sabharwal N, Carstens SA, Kung PC, Vaughan JH (1982) Synovial fluid lymphocytes differ from peripheral blood lymphocytes in patients with rheumatoid arthritis. J Immunol 128:351–354PubMedGoogle Scholar
  19. 19.
    Frank ST, Weg JG, Harkleroad LE, Fitch RF (1973) Pulmonary dysfunction in rheumatoid disease. Chest 63:27–34PubMedCrossRefGoogle Scholar
  20. 20.
    Garcia JG, Parhami N, Khanijo V, Garcia P, Keogh BA (1984) Bronchoalveolar lavage of the lower respiratory tract in rheumatoid arthritis. Chest 86:300AGoogle Scholar
  21. 21.
    Garcia JGN, Parhami N, Killam D, Garcia PL, Keogh BA (1986) Bronchoalveolar lavage fluid evaluation in rheumatoid arthritis. Am Rev Respir Dis 133:450–454PubMedGoogle Scholar
  22. 22.
    Godard P, Clot J, Jonquet O, Bousquet J, Michel FB (1981) Lymphocyte subpopulations in bronchoalveolar lavages of patients with sarcoidosis and hypersensitivity pneumonitis. Chest 80:447–452PubMedCrossRefGoogle Scholar
  23. 23.
    Herzog CA, Miller RR, Hoidal JR (1981) Bronchiolitis and rheumatoid arthritis. Am Rev Respir Dis 124:636–639PubMedGoogle Scholar
  24. 24.
    Hoffmann RA, Kung PC, Hansen WP, Goldstein P (1980) Simple and rapid measurement of human T-lymphocytes and their subclasses in peripheral blood. Proc Natl Acad Sci USA 77:4914–4917CrossRefGoogle Scholar
  25. 25.
    Hunninghake GK, Fauci AS (1979) Pulmonary involvement in the collagen vascular diseases. Am Rev Respir Dis 119:471–450PubMedGoogle Scholar
  26. 26.
    Hatron PY, Wallaert B, Gosset D, Tonnel AB, Gosselin B, Voisin C, Devulder B (1987) Subclinical lung inflammation in primary Sjögren’s syndrome. Arthritis Rheum 30:1226–1231PubMedCrossRefGoogle Scholar
  27. 27.
    Janossy G, Duke O, Poulter LW, Panayi G, Bofill M, Goldstein G (1981) Rheumatoid arthritis: a disease of T-lymphocyte/macrophage immunoregulation. Lancet 1:839–842CrossRefGoogle Scholar
  28. 28.
    Koch B, Locher P, Burmester GR, Mohr W, Kalden JR (1984) The tissue architecture of synovial membranes in inflammatory and noninflammatory joint diseases. II. The localization of mononuclear cells as detected by monoclonal antibodies directed against T-lymphocyte subsets and natural killer cells. Rheumatol Int 4:79–85PubMedCrossRefGoogle Scholar
  29. 29.
    Lasky HP, Bauer K, Pope RM (1988) Increased helper inducer and decreased suppressor inducer phenotypes in the rheumatoid joint. Arthritis Rheum 31:52–59PubMedCrossRefGoogle Scholar
  30. 30.
    Martel W, Abell MR, Mikkelsen WM, Whitehouse WM (1968) Pulmonary and pleural lesions in rheumatoid disease. Radiology 90:641–653PubMedGoogle Scholar
  31. 31.
    Minato N, Takeda A, Kano S, Takaku F (1982) Studies of the function of natural killer-interferon system in patients with Sjögren’s syndrome. J Clin Invest 69:581–588PubMedCrossRefGoogle Scholar
  32. 32.
    Miyasaka N, Seaman W, Bakshi A, Sauvezie B, Strand V, Pope R, Talal N (1983) Natural killing activity in Sjögren’s syndrome. Arthritis Rheum 26:954–960PubMedCrossRefGoogle Scholar
  33. 33.
    Paradis IL, Dauber JH, Rabin BS (1986) Lymphocyte phenotypes in bronchoalveolar lavage and lung tissue in sarcoidosis and idiopathic pulmonary fibrosis. Am Rev Respir Dis 133:855–850PubMedGoogle Scholar
  34. 34.
    Patterson CD, Harville WE, Pierce JA. Rheumatoid lung disease. Ann Intern Med 62:685–697Google Scholar
  35. 35.
    Pedersen BK, Oxholm P (1988) Impaired release of natural killer cytotoxic factor in patients with primary Sjögren’s syndrome. Clin Exp Immunol 72:299–302PubMedGoogle Scholar
  36. 36.
    Petty TL, Wilkins M (1966) The five manifestations of rheumatoid lung. Chest 49:75–82CrossRefGoogle Scholar
  37. 37.
    Popp W, Braun O, Zwick H, Rauscher H, Ritschka L (1989) Increased expression of HLA-DR antigen on alveolar macrophages in pulmonary diseases. Virchows Arch Pathol Anat 414:393–397CrossRefGoogle Scholar
  38. 38.
    Popper MS, Bogdonoff ML, Hughes RL (1972) Interstitial rheumatoid lung diseases. A reassessment and review of the literature. Chest 62:243–249PubMedCrossRefGoogle Scholar
  39. 39.
    Reinherz EL, Morimoto C, Penta AC, Schlossmann SF (1981) Subpopulations of the T4+ inducer T cell subsets in man: evidence for an amplifier population preferentially expressing Ia antigen upon activation. J Immunol 126:67–72PubMedGoogle Scholar
  40. 40.
    Reynolds HY (1987) Bronchoalveolar lavage. Am Rev Respir Dis 135:250–263PubMedGoogle Scholar
  41. 41.
    Sachs L (1984) Angewandte Statistik, 6th ed. Berlin: Springer VerlagGoogle Scholar
  42. 42.
    Sharp JT, Calkins E, Cohen AS, Schubart AF, Culabro JJ (1964) Observation on the clinical, chemical, and serological manifestation of rheumatoid arthritis, based on the course of 154 cases. Medicine 43:41–58PubMedCrossRefGoogle Scholar
  43. 43.
    Spencer H (1985) Pathology of the Lung, Vol. 2, 4th ed. Oxford: Pergamon Press, pp. 807–814Google Scholar
  44. 44.
    Strimlan CV, Rosenow EC, Divertie MB, Harrison EG (1976) Pulmonary manifestations of Sjögren’s syndrome. Chest 70:354–361PubMedCrossRefGoogle Scholar
  45. 45.
    Strumpf IJ, Feld MK, Cornelius MJ, Keogh BA, Crystal RG (1981) Safty of fiberoptic bronchoalveolar lavage in evaluation of interstitial lung disease. Chest 80:268–271PubMedCrossRefGoogle Scholar
  46. 46.
    Talbott JA, Calkins E (1964) Pulmonary involvement in rheumatoid arthritis. JAMA 189:911–913PubMedGoogle Scholar
  47. 47.
    Thomas PD, Hunninghake GW (1987) Current concepts of the pathogenesis of sarcoidosis. Am Rev Respir Dis 135:747–760PubMedGoogle Scholar
  48. 48.
    Tishler M, Greif J, Fireman E, Yaron M, Topilsky M (1986) Bronchoalveolar lavage—a sensitive tool for early diagnosis of pulmonary involvement in rheumatoid arthritis. J Rheumatol 13:547–550PubMedGoogle Scholar
  49. 49.
    Turner-Warwick M, Haslam PL (1987) The value of serial bronchoalveolar lavages in assessing the clinical progress of patients with cryptogenic fibrosing alveolitis. Am Rev Respir Dis 135:26–34PubMedGoogle Scholar
  50. 50.
    Veys EM, Hermanns P, Verbruggen G, Schindler J, Goldstein G (1982) T lymphocytes in blood and synovial fluid in rheumatoid arthritis. Lancet 1:225–226PubMedCrossRefGoogle Scholar
  51. 51.
    Walker WC, Wright V (1968) Pulmonary lesions and rheumatoid arthritis. Medicine 47:501–520PubMedCrossRefGoogle Scholar
  52. 52.
    Walker WC, Wright V (1969) Diffuse interstitial pulmonary fibrosis and rheumatoid arthritis. Ann Rheum Dis 28:252–259PubMedCrossRefGoogle Scholar
  53. 53.
    Wallaert B, Harton PY, Grosbois JM, Tonnel AB, Devulder B, Voisin C (1986) Subclinical pulmonary involvement in collagen vascular diseases assessed by bronchoalveolar lavage. Am Rev Respir Dis 133:574–580PubMedGoogle Scholar
  54. 54.
    Wallaert B, Prin L, Hatron PY, Ramon P, Tonnel AB, Voisin C (1987) Lymphocyte subpopulations in bronchoalveolar lavage in Sjögren’s syndrome. Evidence for an expansion of cytotoxic/suppressor subset in patients with alveolar neutrophilia. Chest 92:1025–1031PubMedCrossRefGoogle Scholar
  55. 55.
    Yousem SA, Colby TV, Carrington CB (1985) Lung biopsy in rheumatoid arthritis. Am Rev Respir Dis 131:770–777PubMedGoogle Scholar

Copyright information

© Springer-Verlag 1990

Authors and Affiliations

  • Wolfgang Popp
    • 3
  • Leopold Ritschka
    • 3
  • Othmar Scherak
    • 1
  • Otto Braun
    • 2
  • Gernot Kolarz
    • 1
  • Helmuth Rauscher
    • 3
  • Hartmut Zwick
    • 3
  1. 1.Ludwig Boltzmann Institut für Rheumatologie und FokalgeschehenBaden bei Wien
  2. 2.Pathologisch-Anatomisches Institut der Universität WienViennaAustria
  3. 3.Lungenabteilung, Krankenhaus der Stadt Wien-LainzViennaAustria

Personalised recommendations