Clinics in chest medicine
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Clinics in chest medicine · Sep 2010
ReviewUtility of bronchoalveolar lavage in evaluation of patients with connective tissue diseases.
Pulmonary involvement is common in patients with connective tissue diseases (CTDs), and significantly contributes to morbidity and mortality in this patient population. There are different forms of lung pathology in CTDs, which include primary involvement such as interstitial lung disease or pulmonary hemorrhage, and pulmonary complications resulting from other CTD-related organ involvement including aspiration pneumonia due to muscle weakness or esophageal fibrosis. Moreover, iatrogenic lung disease, such as medication-induced hypersensitivity pneumonitis or opportunistic infections due to immunosuppression, may develop. ⋯ Moreover, in view of the broad variability of clinical course of CTD-related interstitial lung disease, identification of biomarkers helpful in predicting prognosis becomes of key importance. In addition to radiological assessment and functional testing that provide information regarding localization and severity of lung disease, bronchoalveolar lavage (BAL) appears helpful in revealing the nature of lung pathology and intensity of lung inflammation through sampling of cells and fluid from the lower respiratory tract. The aim of this article is to critically review available data concerning the evaluation of BAL cytology in different forms of lung disease associated with CTDs.
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Sjögren syndrome is a slowly progressing autoimmune disease. Pulmonary manifestations are frequent in primary Sjögren syndrome but often not clinically significant; the most common are xerotrachea, interstitial lung diseases, and small airway obstruction. Pulmonary manifestations in Sjögren syndrome have a slow progression and favorable prognosis, with the exception of primary pulmonary lymphoma and pulmonary hypertension.
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Clinics in chest medicine · Sep 2010
ReviewPulmonary manifestations of systemic lupus erythematosus.
Systemic lupus erythematosus (SLE) is a potentially severe, frequently disabling autoimmune disease with multiorgan involvement and a typically waxing and waning course. SLE is often considered the prototypical autoimmune disease. Although SLE has the potential to affect any organ, the lungs are commonly involved later in the course of the disease in the setting of other organ involvement. ⋯ The most common pulmonary manifestation attributable to SLE is pleuritis, but other pleural involvement can be seen, as well as parenchymal disease, pulmonary vascular disease, diaphragmatic dysfunction, and upper airway dysfunction. Finding the true prevalence of lung involvement with SLE is complicated by the high rates of pulmonary infections. This article reviews the diverse clinical symptoms and immunologic pulmonary manifestations of SLE.
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Clinics in chest medicine · Sep 2010
ReviewPulmonary manifestations of the idiopathic inflammatory myopathies.
Pulmonary involvement in myositis includes interstitial lung disease (ILD), respiratory muscle weakness, aspiration, infections, and drug-induced disease. ILD may precede myositis, and results in increased morbidity and mortality rates. ⋯ Nonspecific interstitial pneumonia (NSIP) is the most common histologic pattern on lung biopsy. Treatment usually consists of a combination of steroids and other immunosuppressive agents, and the response depends on the clinical presentation and underlying histology.