Smoking and the risk of systemic lupus erythematosus: an updated systematic review and cumulative meta-analysis

Abstract

Published articles reported controversial results about the association of smoking with the risk of systemic lupus erythematosus (SLE). A meta-analysis was performed to assess the aforementioned association and arrive at a more precise estimate of effect. A comprehensive search was performed to identify case-control or cohort studies (from 1990 to 2015) of the aforementioned association. The I (2) statistic was used to examine between-study heterogeneity. Fixed or random effect model was selected based on heterogeneity test among studies. Publication bias was estimated using Egger's regression asymmetry test. A total of 12 published articles with 13 studies were finally included in our meta-analysis. Results showed that the pooled odds ratio (OR) for SLE risk was 1.56 (95% confidence interval (CI) = 1.26-1.95) among current smokers compared with nonsmokers. For ex-smokers versus nonsmokers, the pooled OR for SLE risk was 1.23 (95% CI = 0.93-1.63). Subgroup analysis by geographic location and cumulative meta-analysis were also analyzed. In conclusion, our meta-analysis suggested that smoking increased the risk of SLE. Further studies are needed to confirm this result.

Relationship of Cigarette Smoking and Alcohol Consumption to Incidence of Systemic Lupus Erythematosus in a Prospective Cohort Study of Black Women

“…Cigarette smoking has been associated with SLE risk in several, but not all, past studies . Two past meta‐analyses of these studies have pointed to current smoking, more than past smoking, as increasing SLE risk . A recent prospective study demonstrated an increased risk of anti–double‐stranded DNA positive (anti‐dsDNA+) SLE, but not overall SLE, with current smoking.…”

Association between cigarette smoking and impaired clinical symptoms in systemic sclerosis: A review

“…Investigations into the potential impact of tobacco exposure on the development and outcome of certain autoimmune diseases, in particular rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), have been carried out extensively during the last decade [3,4,13]. There are various studies demonstrated that cigarette smoking is associated with worse disease manifestations of SSc, but the role of cigarette smoking as a risk factor for disease susceptibility in SSc has been rarely reported.…”

“…These changes could eventually, in the course of years or decades, lead to the development of an autoimmune disease. Recently, smoking has been found to be an environmental risk factor for the development to autoimmune diseases, e.g., rheumatoid arthritis [3] and SLE [4]. Unfortunately, no studies has associated smoking with increased prevalence of SSc, but several associations with disease manifestations have been noted during the last decade.…”

Preventing the development of SLE: identifying risk factors and proposing pathways for clinical care

“…69 Nevertheless, there are no definitive data that quantify the relative contributions of these environmental risk factors to disease development, onset or flare. 70 Among the environmental agents studied in SLE, cigarette smoke [71][72][73][74][75][76][77] and environmental air pollutants 78,79 have attracted significant interest. It should be appreciated that the detrimental effects of cigarette smoking also apply to marijuana smoking.…”