Smoking and Its Association With Morbidity in Systemic Lupus Erythematosus Evaluated by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index: Preliminary Data and Systematic Review

Abstract

Objective. Due to the increased availability of effective treatments, patients with systemic lupus erythematosus (SLE) now have longer survival times, and factors involved in cumulative chronic damage in SLE need to be better understood. This study was undertaken to evaluate the relationship between smoking and cumulative chronic damage in SLE patients.Methods. A cross-sectional study of SLE patients was performed to investigate the possible association between smoking exposure (ever [previous or current, active or secondhand smokers] or never) and cumulative chronic damage as measured by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI). A systematic review of the literature was conducted by cross-searching Medline for the terms lupus and smoking.Results. We enrolled 105 patients with SLE (96% female), with a mean 6 SD age of 40.7 6 11.4 years and a mean followup time of 8.98 years. Of the 105 patients, 74 had an SDI score of 1-10, and 31 had an SDI score of 0. The difference between smoking exposure and no smoking exposure was significant (P 5 0.02 by chi-square test in contingency table analysis), and SLE patients who were never exposed to smoking had 0.78 times the risk of progressing toward a cumulative damage status (SDI score of > 0) (95% confidence interval 0.16-0.98) throughout the followup period compared to those who were ever exposed. In the systematic review of the literature, we found only a small number of articles that addressed some aspects of the relationship between smoking exposure and cumulative damage in SLE patients.Conclusion. Our findings indicate that smoking exposure is associated with cumulative chronic damage, as determined by the SDI score, in patients with SLE. Smoking exposure may have deleterious effects on lupus morbidity, and more detailed studies of this association are needed.

Smoking reduces the efficacy of belimumab in mucocutaneous lupus

“…Importantly, an association between tobacco smoking and poor clinical responses in mucocutaneous SLE was observed. Our findings provide important information with respect to previous reports of a negative impact of smoking on SLE disease activity and damage [14,15], as well as on drug efficacy [19].…”

“…In RA, smoking has been shown to decrease the efficacy of methotrexate and TNF inhibitors [12,13]. In SLE, smoking has been found to contribute to the development of the disease, as well as to disease severity and organ damage [14,15].…”

Patient Perspectives on Smoking Cessation and Interventions in Rheumatology Clinics

“…Patients with RA who smoke require more disease‐modifying antirheumatic drugs and are less likely to respond to methotrexate and tumor necrosis factor inhibitors than those who previously smoked or never smoked . Patients with SLE who have a history of smoking have higher disease activity and higher chronic damage index scores than those without a history of smoking. Likewise, data show that, among patients with SLE who smoke, cutaneous disease is more prevalent and less treatable with hydroxychloroquine .…”

“…Smoking is a leading risk factor for cardiovascular disease (CVD) incidence and rheumatic disease severity (1)(2)(3). Recognizing that rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) increase the risk of premature CVD (4,5), the European League Against Rheumatism and other experts recommend smoking cessation care for rheumatology patients (6)(7)(8)(9).…”

Fatores Determinantes de Morbilidade nos Doentes com Lúpus Eritematoso Sistémico

“…Foram destacados: atividade da doença (artrite, eritema malar, nefropatia ativa, febre, envolvimento neurológico, fenómeno Raynaud, serosite, trombocitopenia e trombose), infeções, hipertensão arterial, dislipidemia, tabagismo, osteoporose, citopenias relacionadas com o uso de imunossupressores e neoplasias. [16][17][18] Para efeitos de estudos observacionais são habitualmente incluídos doentes com um número mínimo de quatro critérios ACR de classificação de LES, 19 preenchidos de forma cumulativa, ao longo do seguimento clínico, sem uma duração de acumulação de critérios pré-definida. Até à presente data, não foi desenvolvido um índice que permita relacionar a forma global de apresentação da doença com o seu prognóstico.…”