Cigarette smoking in primary Sjögren’s syndrome: positive association only with ANA positivity

Abstract

Smoking is well known to contribute to the pathogenesis and severity of some systemic autoimmune rheumatic diseases and especially to the production of certain autoantibodies. Primary Sjögren's syndrome (pSS) is an autoimmune disease, affecting primarily the exocrine glands. It may also cause extraglandular involvement in some cases. In this study, we aimed to determine the frequency of smoking habits in our cohort of pSS patients and to investigate whether the frequencies of autoantibody positivity and extraglandular involvement were significantly different between patients with and without smoking. In this cross-sectional study, 207 patients with pSS (F/M 203/4), fulfilling the United States-European Consensus Criteria, and 602 healthy controls (F/M 534/68) were included. Patients and controls were classified into five groups: never smokers, current smokers, former smokers; ever smokers, and passive smokers. The χ(2) and Kruskal-Wallis tests were used for statistical analysis; a p value of less than 0.05 was accepted as statistically significant. While the frequency of current smokers was significantly lower in the pSS group compared with the healthy controls (11.6 vs 22.3%), the frequencies of former smokers (30.4 vs 11.8%), ever smokers (42.0 vs 34.1%), and passive smokers (47.3 vs 37.5%) were significantly higher in the pSS group compared with the healthy controls. In pSS patients, only antinuclear antibody (ANA) positivity was significantly associated with smoking habits, while there was no significant association with other autoantibodies or with the presence of extraglandular involvement. We found that in pSS patients smoking was significantly associated only with ANA positivity. Unlike the deleterious effects of smoking upon disease severity and anti-cyclic citrullinated protein (CCP) antibody production in rheumatoid arthritis, we could not find any association of smoking with extraglandular involvement and/or anti-Ro/anti-La antibody positivity in pSS. These results are indeed in line with the limited number of previous studies reported in the literature. Further studies with higher numbers of pSS patients are required to confirm the seemingly negative association of smoking with pSS.

Smoking is not associated with autoantibody production in systemic lupus erythematosus patients, unaffected first-degree relatives, nor healthy controls

“…Our study found no significant relationship between ANA positivity by immunofluorescence nor by luminex bead-based assay and smoking status, contrary to a previous study which found an association in Sjogren’s syndrome 8 . While there were different levels of ANA positivity between our subjects with SLE, our unaffected FDRs and our healthy controls, there were no significant differences by smoking status in the proportion of individuals positive for ANA in any of these groups.…”

“…Smoking has also been associated with seropositivity for SLE-related autoantibodies, including anti-dsDNA in individuals with SLE 7 , and ANA in primary Sjogren’s syndrome 8 . In addition, smoking appears to play a role in autoantibody positivity in other autoimmune diseases, namely rheumatoid arthritis (RA) 9–19 .…”

Auto-Antibodies and Their Association with Clinical Findings in Women Diagnosed with Microscopic Colitis

“…The associations observed could be due to secondary effects on the digestive tract of the diseases, or their treatment, and do not necessarily mean a common causal aetiology [1]. Smoking per se is associated with a higher prevalence of ANA [30], and this could explain the higher ANA positivity in our study with a high frequency of former and current smokers. Thus, our finding in the present study does not indicate that auto-immunity is the most important cause of MC.…”

Subgroups of Sjögren syndrome patients according to serological profiles

“…In addition, it has been found that ANA titres correlate with the number of positive autoantibodies against specific nuclear antigens, as well as with the percentage and levels of serum gammaglobulins [5,24]. Finally, a cross-sectional study from Turkey, including 207 pSS patients and 602 healthy controls, suggested an association of smoking with ANA positivity in the SS group [44].…”