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Inflammatory markers and pulmonary granuloma infiltration in sarcoidosis.

Respirology. 2013 Dec 24;

Authors: Terčelj M, Salobir B, Zupancic M, Wraber B, Rylander R

Abstract
BACKGROUND AND OBJECTIVE: Previous studies have demonstrated increases of inflammatory mediators in sarcoidosis while epidemiological studies have also demonstrated an association with increased fungi exposure. This study measured the level of β-glucan in the lungs and of inflammatory mediators in serum, and correlated both with the extent of pulmonary granuloma infiltration.
METHODS: This is a cross-sectional study of 98 patients with sarcoidosis and 26 controls. β-glucan, a cell wall constituent of fungi, was measured in bronchoalveolar lavage. Inflammatory mediator levels were determined in serum. The extent of granuloma infiltration was estimated on the chest X-ray. Exposure to fungi at home was determined by taking air samples in bedrooms and analysing for the presence of β-N-acetylhexosaminidase.
RESULTS: Significantly, higher levels of β-glucan were found in broncho-alveolar lavage in subjects with sarcoidosis as compared with controls. There were significant positive relationships between the extent of granuloma infiltration and the levels of the different inflammatory mediators, except for interleukin-10. Domestic fungal exposure was higher among subjects with sarcoidosis.
CONCLUSIONS: This is the first time that a specific agent, previously suspected to be related to the risk of sarcoidosis, has been detected in the lung of subjects with sarcoidosis and related to the levels of inflammatory mediators and the degree of home exposure to fungi. The results suggest that exposure to fungi should be explored when investigating patients with sarcoidosis.

PMID: 24372709 [PubMed - as supplied by publisher]

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Methotrexate and lung disease in rheumatoid arthritis - A meta-analysis of randomized controlled trials.

Arthritis Rheum. 2013 Dec 24;

Authors: Conway R, Low C, Coughlan RJ, O'Donnell MJ, Carey JJ

Abstract
Objective Methotrexate has shown efficacy in treating several diseases, especially rheumatoid arthritis (RA). Methotrexate has been implicated as a causative agent in interstitial lung disease. Patients with RA may develop pulmonary manifestations of their disease and are at increased risk of respiratory infections. The aim of this study was to evaluate the relative risk of pulmonary disease among RA patients treated with methotrexate. Methods We searched Pubmed and Cochrane databases between 1(st) January 1990 and 1(st) February 2013 for double-blind randomised controlled trials of methotrexate versus placebo or active comparator agents in adults with RA. Studies with less than 100 subjects or of less than 24 weeks duration were excluded. Two investigators independently searched both databases. All authors reviewed selected studies. We compared relative risk (RR) differences using the Mantel-Haenszel random effects method. Results A total of 22 studies with 8584 participants met our inclusion criteria. Heterogeneity across the studies was not significant (I(2) =3%), allowing combination of trial results. Methotrexate was associated with an increased risk of all adverse respiratory events, RR 1.10(CI 1.02-1.19), and respiratory infections, RR 1.11(CI 1.02-1.21). Patients treated with methotrexate were not at increased risk of pulmonary death, RR 1.53(CI 0.46-5.01), or non-infectious respiratory events, RR 1.02(CI 0.65-1.60). A subgroup analysis of studies reporting pneumonitis revealed an increased risk with methotrexate, RR 7.81(CI 1.76-34.72). Conclusion Our study found a small but significant increase in the risk of lung disease in RA patients treated with methotrexate compared to other disease-modifying antirheumatic drugs and biologic agents. © 2013 American College of Rheumatology.

PMID: 24374778 [PubMed - as supplied by publisher]