BRONCHOALVEOLAR LAVAGE IN RHEUMATOID ARTHRITIS

Bronchoalveolar lavage (BAL) was performed on 70 RA patients,28 without extra-articular manifestations, nine with pulmonaryinvolvement, 13 with sicca-syndrome, 20 with other extra-articularmanifestations such as renal involvement, cutaneous vasculitisand rheumatoid nodules. Fifteen patients without rheumatic orpulmonary disease served as the control group. Compared withthe control group RA patients showed a statistically significantincrease of lymphocytes, especially of activated (DR+)T(CD3+)-helper(CD4+) cells, resulting in a significantly diminished percentageof alveolar macro-phages, B(CD21+)-lymphocytes, T-suppressor(CD8+) cells and an increased CD4/CD8 ratio. This cell distributionpattern was more pronounced in RA patients with lung involvementwith significant differences to the other RA patients with regardto lymphocytes, DR positive cells and CD4 positive/DR positivecells. It is concluded that these results indicate an alteredbalance of immunocompetent cells not only in the joints butalso in the lung. The changes are more distinct if local manifestationscan be diagnosed clinically. KEY WORDS: Bronchoalveolar lavage, Rheumatoid arthritis, Pulmonary manifestation, Lymphocyte subsets