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a Department of
Pulmonary and Critical Care Medicine, Eugenidio Hospital, Athens,
Greece, b Department of
Internal Medicine, Medical School, University of Ioannina, Ioannina,
Greece, c Department of Critical Care Medicine, Medical
School, National and Kapodestrian University, Athens, Greece, d Department
of Pathophysiology, Medical School, National and Kapodestrian
University, Athens, Greece, e Department of Nutrition and Diatetics, Harokopio
University, Athens, Greece
Correspondence to: Dr F N Skopouli, Department of Nutrition and Diatetics, Harokopio University, 70 El Venizelou Street, 176 71 Athens, Greece.
Accepted for publication 23 September 1998
OBJECTIVE
To evaluate
lung involvement in patients with primary Sjögren's syndrome.
METHODSSixty
one consecutive, non-smoking patients, 58 women and three men, were
evaluated clinically, physiologically, and radiologically. A bronchial
and/or transbronchial biopsy was performed on 13 of the patients.
Physiological data were compared with that of a control group of 53 healthy non-smoking subjects matched for age and sex.
RESULTSIn 41%
of the patients the main symptom was dry cough. Physiological studies
revealed that the patients presented significantly lower expiratory
flow values (% pred) when compared with those of the control group:
the forced expiratory volume in one second (FEV1) (mean
(SD)) was 96% (16) v 111% (13)
(p<0.0001), the maximal expiratory flow at the 50% of the vital
capacity (MEF50) was 72% (24) v
103% (17) (p<0.0001), and the maximal expiratory flow at the 25% of
the vital capacity (MEF25) was 49% (25)
v 98 % (20) (p<0.0001). No significant
difference was noted for the carbon monoxide diffusion value (% pred),
between patients and controls. Blood gases were evaluated in 44 patients: mild hypoxemia was observed, and the alveolo-arterial oxygen
difference (P(A-a)O2) correlated significantly
with MEF50 (r=0.35, p<0.01) and
MEF25 (r=0.33, p<0.01) values.
Chest radiography showed mild, interstitial-like changes in 27 patients
while slightly increased markings were present in 21. High resolution
computed tomography of the lungs was performed in 32 patients (four
with a normal chest radiograph, six with suspected interstitial
pattern, 19 with apparent interstitial pattern, and three with
hyperinflation) and revealed predominantly wall thickening at the
segmental bronchi. All positive findings by computed tomography derived
from the patients with abnormal chest radiographs. Transbronchial
and/or endobronchial biopsy specimens in 10 of the 11 sufficient tissue
samples revealed peribronchial and/or peribronchiolar mononuclear
inflammation, while interstitial inflammation coexisted in two patients.
CONCLUSIONThe airway
epithelia seem to be the main target of the inflammatory lesion of the
lung in patients with primary Sjögren's syndrome. It seems to be
common, subclinically leading to obstructive small airway physiological abnormalities.
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