Smoking, disease activity, permanent damage and dsDNA autoantibody production in patients with systemic lupus erythematosus

Abstract

The aim was to study the association of smoking with the activity and severity of systemic lupus erythematosus (SLE) and the production of antibodies to dsDNA. The study included 223 SLE patients attending the outpatient clinics at Helsinki University Central Hospital. The history of smoking was obtained by personal interview, and clinical data related to SLE by interview, clinical examination and chart review. The activity of SLE was assessed by the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score and permanent damage by the SLICC/ACR score. Antibodies to dsDNA were determined by three ELISA assays, by the indirect immunofluorescence technique using Crithidia luciliae cells as substrates and by the Farr assay. There were no significant differences in the SLEDAI scores between current smokers (73 patients), ex-smokers (59) and never-smokers (91), though current smokers tended to have lower disease activity. The SLICC/ACR scores between the groups were practically equal. Current smokers had significantly lower levels of antibodies to dsDNA than ex- and never-smokers (p = 0.025). Our study suggests that cigarette smoke may have immunosuppressive effect on autoantibody production in patients with SLE. Permanent damage was not found to be associated with smoking.

Serologic antibodies in relation to outcome in postoperative Crohn's disease

“…We have demonstrated lower humoral immune activation in current and past smokers across multiple antibodies. This has been shown previously in periodontal disease, systemic lupus erythematosus, healthy subjects, and in a cohort of 113 Crohn's disease patients using only a single antibody (ASCA) . That past smokers cluster with current smokers in the presence and magnitude of these antibodies suggests that immune down‐regulation may not resolve on cessation of smoking; this remains to be tested with stricter smoking criteria.…”

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

“…More recently, Gustafsson et al found an association between smoking and an SDI score of >1 (data related to SDI scores of >0 were not available) in a study of the development of pathogenic antiphospholipid antibodies in current and former smokers, but secondhand smokers were not included in the analyses. The study by Ekblom‐Kullberg et al also did not include secondhand smokers and did not assign patients to an “ever” status (current, former, or secondhand smoker) versus a “never” status as the present study does. Further, they found no significant differences in SDI score between current or former smokers versus never smokers.…”

“…To emphasize the need for more data regarding the cumulative chronic effects of smoking in SLE, we performed a small systematic review. We found more than 222,000 papers about smoking, but only 6 were directly related to smoking exposure and chronic damage among SLE patients (25)(26)(27)(28)(29)(30). Apart from studies that we may have missed in our short systematic review, it seems that the medical literature does not include much on this subject.…”

Exposure to Air Pollutants and Disease Activity in Juvenile‐Onset Systemic Lupus Erythematosus Patients

“…Therefore, further studies with individual monitors capable of measuring exposures in real time should be conducted. Second, individual data on potential confounders, such as body surface area, age, exposure to sunlight, and exposure to cigarette smoke were not available, although the effect of smoking on SLE disease activity has been debated (21,22). Additionally, the possibility of casual results cannot be completely excluded.…”