Background/Purpose: There are controversies around the role of smoking in manifestations of axial spondyloarthritis (axSpA) such as peripheral involvement. It has been observed an inverse association between alcohol consumption and disease activity and functional impairment, although it is still unclear its association with peripheral manifestations of SpA. Objectives: 1) To evaluate the association between smoking/alcohol intake and the prevalence of peripheral articular manifestations (i.e., arthritis, enthesitis or dactylitis); 2) to assess the association between smoking/alcohol intake and the specific location of such manifestations.

Methods: Patients from the cross-sectional ASAS-PerSpA study with available data for both the smoking status and alcohol intake were included. Mixed logistic regressions using the peripheral manifestation (or the location) as a dependent variable, the smoking status or alcohol intake and the presence of psoriasis as fixed effect and the country as random effect were used. The interaction between smoking and alcohol was tested.

Results: A total of 4451 patients with either axSpA, peripheral SpA or Psoriatic Arthritis were included in the analysis. 59.5% had smoked at any moment and 42.7% had been alcohol drinkers. Patients who have ever suffered arthritis showed a lower frequency of smoking habit (OR 0.72, 95%CI 0.63-0.82) and a lower alcohol consumption(OR 0.82, 95%CI 0.71-0.94) (table 1). In addition, among patients with arthritis, smoking was associated with a predominantly upper limbs involvement (OR 0.78, 95%CI 0.65-0.94), while alcohol was associated with a predominant mono/oligoarticular involvement (OR 1.13, 95%CI 0.94-1.36).

Patients who have ever suffered enthesitis also showed a lower frequency of smoking habit and alcohol intake (OR 0.75, 95%CI 0.63-0.89 and OR 0.69, 95%CI 0.57-0.83, respectively). No association was found with regard to the prevalence of dactylitis.

At the moment of the study visit, 20.4% patients were current smokers and 32.2% consumed alcohol. Current alcohol intake was associated with a lower prevalence of both current arthritis (26.9% vs. 33.6% (OR 0.76, 95%CI 0.64-0.91)) and current enthesitis (21.1% vs. 34.6% (OR 0.78, 95%CI 0.62-0.96)), while current smoking did not show significant differences.

No interaction was found in the association between alcohol and tobacco with regard to the prevalence of peripheral symptoms in the past. However, when assessing current arthritis, current smokers and no drinkers were found to be associated with arthritis in the lower limbs.

Conclusion: Taking into account the country and the presence of psoriasis, smoking and alcohol are associated with a lower prevalence of peripheral manifestations. Smoking seems to be associated with predominantly upper limbs arthritis while alcohol intake seems to be associated with a predominantly oligo/mono articular involvement. Future studies are required including the influence of psoriatic arthritis in the relationship between alcohol and smoking and its association with peripheral manifestations.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/are-smoking-and-alcohol-associated-with-peripheral-musculoskeletal-involvement-in-patients-with-spondyloarthritis-results-from-the-asas-perspa-study/