RESUMO
BACKGROUND: Clinically evident interstitial lung disease (ILD) affects between 10 and 42% of the patients with rheumatoid arthritis (RA). Airway involvement seems to be even more common. Most of the available evidence comes from studies performed in established RA patients. The aim of our study was to know the prevalence of non-diagnosed lung disease (airway and interstitial involvement) in patients with early RA and look for associated factors. METHODS: We designed an observational, multicenter, cross-sectional study, and included patients with RA of less than two years since diagnosis. We performed a structured questionnaire, HRCT and lung functional tests looking for lung disease, together with joint disease evaluation. We analyzed which variables were associated with the presence of lung disease on HRCT. RESULTS: We included 83 patients, 83% females. The median (IQR) of time since RA diagnosis was 3 (1-6) months. In the HRCT, 57 patients had airway compromisea (72%), and 6 had interstitial abnormalities (7.5%). The most common altertion found in lung functional tests was a reduced DLCO (14%). The presence of at least one abnormality in the physical exam was associated with lung involvement on HRCT [13 (21.6%) vs 0 (0%); p = 0.026]. Also, patients with lung involvement presented significantly lower values of FVC% and DLCO%, and higher values of RV/TLC. No variable related to joint involvement was found associated with alterations in HRCT. CONCLUSION: Our study shows that a large proportion of early RA patients has abnormal findings in HRCT. Further studies are required to confirm these findings.
Assuntos
Artrite Reumatoide , Doenças Pulmonares Intersticiais , Artrite Reumatoide/epidemiologia , Estudos Transversais , Feminino , Humanos , Doenças Pulmonares Intersticiais/epidemiologia , Masculino , PrevalênciaRESUMO
Las Enfermedades Pulmonares Intersticiales Difusas (EPID) se caracterizan por inflamación y fibrosis. El rol del lavado broncoalveolar (LBA) en el diagnóstico delas EPID, ha sido recientemente revalorizado. El objetivo de este trabajo fue evaluar los niveles de citoquinas inflamatorias del LBA asociado a las EPID. Recolectamos LBA de 28 pacientes con EPID y 15 sujetos con pulmones sanos. Realizamos el recuento total de células del LBA y determinamos los niveles de citoquinas por ELISA. Encontramos un incremento significativo en el número total de células y en los niveles de IL-6 en el LBA de los pacientes con Neumonía Intersticial no Específica (NINE), Neumonitis por Hipersensibilidad (NH) y Sarcoidosis en comparación con el grupo control. También, observamos un significativo incremento de IL-8 en el LBA de los pacientes con Fibrosis Pulmonar Idiopática /Neumonía Intersticial Usual (FPI/NIU) comparados con el grupo control. No encontramos relación entre los niveles de citoquinas y los parámetros de función pulmonar. El LBA podría jugar un importante rol para entender los procesos inflamatorios asociados a las EPID. Cuando el LBA es utilizado en conjunto con la información clínica completa, el recuento diferencial y el patrón inflamatorio; este podría contribuir con la evaluación diagnóstica. Sin embargo, el procesamiento del LBA y el análisis de este fluido son críticos para poder aprovechar dicha información. En este estudio, evaluamos la utilización del LBA como una herramienta para comprender los patrones inflamatorios asociados con las EPID.
Interstitial Lung Diseases (ILD) are characterized by inflammation and fibrosis. The role of bronchoalveolar lavage (BAL) in the diagnosis of ILD, has been recently revalued. The aim of this work was to evaluate BAL´s inflammatory cytokines associated with ILD. We collected BAL from 28 patients with ILD and15 control subjects with healthy lungs. We counted the whole BAL cell number and determined cytokines levels by ELISA. We found a significant increase in the whole BAL cell count and IL-6 levels in patients with fibrotic non-specific interstitial pneumonia (NSPI), hypersensitivity pneumonitis (HP) and sarcoidosis in comparison with the control group. We also observed a significant increase of IL-8 in BAL from usual interstitial pneumonia/idiopathic pulmonary fibrosis (UIP/IPF) in comparison with the control group. We didn´t find relationship between cytokines levels and lung function parameters. BAL could play an important role to understand the inflammatory process associated with ILD. When BAL is used together with complete clinical information, BAL cell differential count and inflammatory patterns could contribute to the diagnostic evaluation. BAL processing and analysis of this fluid are critically important for providing useful information. In this study we evaluated the use of BAL as a research tool to understand inflammatory patterns associated with ILD.
Assuntos
Citocinas , Doenças Pulmonares Intersticiais , Lavagem BroncoalveolarRESUMO
Las Enfermedades Pulmonares Intersticiales Difusas (EPID) se caracterizan por inflamación y fibrosis. El rol del lavado broncoalveolar (LBA) en el diagnóstico delas EPID, ha sido recientemente revalorizado. El objetivo de este trabajo fue evaluar los niveles de citoquinas inflamatorias del LBA asociado a las EPID. Recolectamos LBA de 28 pacientes con EPID y 15 sujetos con pulmones sanos. Realizamos el recuento total de células del LBA y determinamos los niveles de citoquinas por ELISA. Encontramos un incremento significativo en el número total de células y en los niveles de IL-6 en el LBA de los pacientes con Neumonía Intersticial no Específica (NINE), Neumonitis por Hipersensibilidad (NH) y Sarcoidosis en comparación con el grupo control. También, observamos un significativo incremento de IL-8 en el LBA de los pacientes con Fibrosis Pulmonar Idiopática /Neumonía Intersticial Usual (FPI/NIU) comparados con el grupo control. No encontramos relación entre los niveles de citoquinas y los parámetros de función pulmonar. El LBA podría jugar un importante rol para entender los procesos inflamatorios asociados a las EPID. Cuando el LBA es utilizado en conjunto con la información clínica completa, el recuento diferencial y el patrón inflamatorio; este podría contribuir con la evaluación diagnóstica. Sin embargo, el procesamiento del LBA y el análisis de este fluido son críticos para poder aprovechar dicha información. En este estudio, evaluamos la utilización del LBA como una herramienta para comprender los patrones inflamatorios asociados con las EPID.(AU)
Interstitial Lung Diseases (ILD) are characterized by inflammation and fibrosis. The role of bronchoalveolar lavage (BAL) in the diagnosis of ILD, has been recently revalued. The aim of this work was to evaluate BAL´s inflammatory cytokines associated with ILD. We collected BAL from 28 patients with ILD and15 control subjects with healthy lungs. We counted the whole BAL cell number and determined cytokines levels by ELISA. We found a significant increase in the whole BAL cell count and IL-6 levels in patients with fibrotic non-specific interstitial pneumonia (NSPI), hypersensitivity pneumonitis (HP) and sarcoidosis in comparison with the control group. We also observed a significant increase of IL-8 in BAL from usual interstitial pneumonia/idiopathic pulmonary fibrosis (UIP/IPF) in comparison with the control group. We didn´t find relationship between cytokines levels and lung function parameters. BAL could play an important role to understand the inflammatory process associated with ILD. When BAL is used together with complete clinical information, BAL cell differential count and inflammatory patterns could contribute to the diagnostic evaluation. BAL processing and analysis of this fluid are critically important for providing useful information. In this study we evaluated the use of BAL as a research tool to understand inflammatory patterns associated with ILD.(AU)
RESUMO
OBJECTIVE: To compare the hypolipidemic effects of gemfibrozil and micronized fenofibrate in patients with primary hyperlipoproteinemia, phenotypes IIa and IIb, with emphasis on their cholesterol-lowering effectiveness. METHODS: A randomized, double-blind, double-dummy, crossover study was performed to assess the effects of gemfibrozil (900 mg) and micronized fenofibrate (200 mg), administered once daily, to 21 patients (45 to 70 years old)-16 with type IIa and 5 with type IIb primary hyperlipidemia. The two treatment periods lasted 6 weeks each; the run-in and washout periods were 4 weeks. RESULTS: Both drugs significantly reduced total cholesterol, calculated low-density lipoprotein (LDL) cholesterol, triglycerides, apolipoprotein B, and fibrinogen (P<0.01 for all calculations, except P<0.05 for fibrinogen with gemfibrozil therapy) and increased high-density lipoprotein (HDL) cholesterol (P<0.01). Neither drug affected Lp(a) lipoprotein, whereas uric acid was reduced only by fenofibrate (P<0.01). The percentage decrease in total cholesterol and LDL cholesterol was greater with fenofibrate than with gemfibrozil (-22% versus -15%, P<0.02; and -27% versus -16%, P<0.02, respectively). In contrast, reductions in levels of triglycerides (-54% versus -46.5%), apolipoprotein B, and fibrinogen, as well as the increase in HDL (+9% for both drugs), showed no significant difference between treatments. Separate analysis of patients with type IIb hyperlipoproteinemia showed essentially the same plasma lipid changes as for the overall group, but with greater modifications in triglyceride and HDL concentrations. CONCLUSION: Fenofibrate and gemfibrozil induced similar variations from baseline values in triglycerides, HDL cholesterol, apolipoprotein B, and fibrinogen, but the decreases in total and LDL cholesterol levels were greater with fenofibrate, in this group of patients with primary hyperlipidemia.