Which Cell Pattern in Immunological Bronchoalveolar Lavage (BAL) Is Associated with a High-resolution Computer Tomography (HRCT) Pattern at the Onset of Inflammatory Rheumatic Disease with Interstitial Lung Disease?

tobias Hoffmann¹, Martin Förster², Peter Oelzner¹, Claus Kroegel², Ulf Teichgräber³, Diane Renz⁴, Joachim Böttcher¹, Christian Schulze², Gunter Wolf¹, Marcus Franz² and Alexander Pfeil¹, ¹Department of Internal Medicine III, Jena University Hospital – Friedrich Schiller University Jena, Jena, Germany, ²Department of Internal Medicine I, Jena University Hospital – Friedrich Schiller University Jena, Jena, Germany, ³Institute of Diagnostic and Interventional Radiology, Jena University Hospital – Friedrich Schiller University Jena, Jena, Germany, ⁴Institute of Diagnostic and Interventional Radiology, Department of Pediatric Radiology, Hannover Medical School, Hannover, Germany

Meeting: ACR Convergence 2023

Keywords: autoimmune diseases, Computed tomography (CT), interstitial lung disease

Session Information

Date: Tuesday, November 14, 2023

Title: (1862–1894) Imaging of Rheumatic Diseases Poster II

Session Type: Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: Inflammatory rheumatic diseases (IRD) are associated with interstitial lung disease (ILD). High-resolution Computer Tomography (HRCT) is recommended as goldstandard in the detection of IRD-ILD. The main HRCT-pattern included ground-glass opacities (GGO), non-specific interstitial pneumonia (NSIP), usual interstitial pneumonia (UIP), granuloma and cryptogenic organizing pneumonia (COP). Further, bronchoalveolar lavage (BAL) can be used to evaluate pulmonal cell pattern. The aim of this study was to evaluate HRCT pattern at the onset of IRD-ILD and to correlate the HRCT pattern to immunological BAL pattern.

Methods: The study includes 61 patients (connective tissue disease n=39, myositis n=9, vasculitis n=10 and rheumatoid arthritis n=3) with newly diagnosed IRD and evidence of ILD on HRCT. In addition to HRCT, immunological BAL was performed. The American Thoracic Society Clinical Practice Guideline were used to define BAL pattern with lymphocytic cellular pattern ( >15% lymphocytes), neutrophilic cellular pattern ( > 3% neutrophils), eosinophilic cellular pattern ( >1% eosinophils) and unspecific cellular pattern. No patient received any immunosuppressive therapy.

Results: For the total study cohort, the main HRCT pattern were NSIP (44.3%) and GGO (31.3%), followed by UIP (14.8%), granuloma (4.9%) and COP (3.3%). BAL pattern showed the following distribution: 37.7% lymphocytic cellular pattern, 27.9% neutrophilic cellular pattern, 18.0% eosinophilic cellular pattern and 16.4% unspecific cellular pattern. Concerning GGO, the main BAL pattern was lymphocytic cellular pattern (47.4%), whereas neutrophilic cellular pattern (37.0%) and lymphocytic cellular pattern (25.9%) were the dominant pattern in NSIP. UIP revealed the following BAL pattern: lymphocytic cellular pattern 55.6%, neutrophilic cellular pattern 33.3% and unspecific cellular pattern 11.1%.

Conclusion: GGO in HRCT is associated with the occurrence of a lymphocytic pattern in BAL, whereas in NSIP and UIP pattern the lymphocytic and neutophilic pattern is equally expressed. Based on the data, a further leading evaluation should be made with regard to the therapeutic options (anti-inflammatory and / or anti-fibrotic therapy) as well as the prognosis of IRD-ILD.

Disclosures: t. Hoffmann: None; M. Förster: None; P. Oelzner: None; C. Kroegel: None; U. Teichgräber: None; D. Renz: None; J. Böttcher: None; C. Schulze: None; G. Wolf: None; M. Franz: None; A. Pfeil: None.

To cite this abstract in AMA style:

Hoffmann t, Förster M, Oelzner P, Kroegel C, Teichgräber U, Renz D, Böttcher J, Schulze C, Wolf G, Franz M, Pfeil A. Which Cell Pattern in Immunological Bronchoalveolar Lavage (BAL) Is Associated with a High-resolution Computer Tomography (HRCT) Pattern at the Onset of Inflammatory Rheumatic Disease with Interstitial Lung Disease? [abstract]. Arthritis Rheumatol. 2023; 75 (suppl 9). https://acrabstracts.org/abstract/which-cell-pattern-in-immunological-bronchoalveolar-lavage-bal-is-associated-with-a-high-resolution-computer-tomography-hrct-pattern-at-the-onset-of-inflammatory-rheumatic-disease-with-interstitia/. Accessed .

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