Bronchoalveolar Lavage in Systemic Sclerosis Patients: A Systematic Review

Introduction: We performed a systematic review of the literature to determine the value of bronchoalveolar lavage (BAL) in evaluating the pulmonary involvement of systemic sclerosis (SSc). Methods: Articles published between 1980 and 2019 were retrieved from the databases: PubMed and Scielo. The search was restricted to clinical trials published in English, utilizing the keywords scleroderma, systemic sclerosis, interstitial lung disease, and bronchoalveolar lavage. Results: Twenty-two papers were analyzed. A positive correlation was observed between increased BAL cellularity (alveolitis) and worsening clinical symptoms, pulmonary function, and radiological pattern in 2, 11, and 15 studies, respectively. The majority of BAL studies that evaluated interleukin levels, including TNF-alpha, IL-6, IL-7, and IL-8, observed higher levels in patients with impaired pulmonary function and increased lung involvement. Conclusions: Alveolitis and the increase of some cytokines/chemokines in BAL were related to more severe pulmonary disease in SSc in the majority of the studies and seemed to be markers of worse prognosis, but it is unknown whether BAL adds clinical value to the use of the other non-invasive diagnostic procedures.

Automated summary

Bronchoalveolar lavage (BAL) can help evaluate pulmonary involvement in patients with systemic sclerosis (SSc), with studies showing a positive correlation between increased BAL cellularity and worsening symptoms, decreased lung function, and radiological changes. Many studies have found higher levels of certain cytokines/chemokines in BAL from SSc patients with impaired lung function and lung involvement.