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A serum marker for the activity of pulmonary fibrosis in patients with systemic sclerosis
  1. A H N Gerratt
  1. SHO in Respiratory Medicine, Hillingdon Hospital, Uxbridge, UK; AnnaGerrattdoctors.org.uk

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Assessing the activity of pulmonary fibrosis in patients with systemic sclerosis requires both bronchoalveolar lavage and serial high resolution computed tomography. A blood test for the diagnosis and monitoring of pulmonary fibrosis would be simpler and less invasive. Serum levels of KL-6 and SP-D show some correlation with severity and activity of disease, but are not particularly reliable. The authors assessed the usefulness of measuring serum levels of pulmonary and activation regulated chemokine (PARC). PARC is expressed at high levels in bronchoalveolar lavage fluid in patients with systemic sclerosis who have pulmonary fibrosis. It may be a marker of immune mediated fibrotic lung disease.

Serum levels of PARC were measured in 123 patients with systemic sclerosis and compared with levels in healthy controls and in patients with systemic lupus erythematosus. PARC levels were significantly higher in the systemic sclerosis group. In a retrospective longitudinal study, serum levels of PARC, KL-6 and SP-D were measured in 21 patients during active and inactive phases of pulmonary fibrosis. Of the three blood tests, PARC levels were found to reflect disease activity most accurately.

This paper does not evaluate the sensitivity of the PARC test in making a diagnosis of pulmonary fibrosis. It does, however, indicate that PARC may be useful in monitoring disease activity in established disease. It should be noted that PARC is not specific for pulmonary fibrosis in systemic sclerosis. Further analysis with a larger number of subjects is indicated.

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