Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Cigarette smoking regulates both innate and adaptive immunity and is associated with numerous diseases. In some inflammatory diseases smoking is associated with deleterious effects but in others, i.e. Ulcerative Colitis, with beneficial effects. The effect in SLE is controversial. This study aims to investigate the associations of current smoking and clinical and serological characteristics of patients with systemic lupus erythematosus at the onset of the disease.
Methods: We included patients with SLE of recent onset (within 12 months of diagnosis), participating in an ongoing lupus cohort since 1970. We analyzed the information of Never Smokers (NS) and Current Smokers (CS) gathered at entry into the cohort, including demographic (age, sex, ethnicity), clinical (lupus criteria, SLEDAI-2K score, treatment, SLICC-DI), and laboratory (ANA, anti-ds-DNA, -Sm, -RNP, -Ro,-La, -aCL, lupus anticoagulant, C3, C4). We also analyzed these variables at one and two years of follow-up. Statistical analysis: Descriptive statistics, chi-square, t-test; multivariable analysis included linear and logistic regression. A p-value of <0.05 indicated statistical significance.
Results: The study included 467 patients [317 (68%) NS, and 150 (33%) CS]; 87% female; mean age 36.1 ± 13.3 years; SLE duration at entry into the cohort 0.2 ± 0.3 years; Caucasian 60%, Black 14%, Other 26%. Males (21.5%) and Caucasians (85.3%) predominated CS (p < 0.001). At entry into the cohort, CS had significantly lower values of ACR criteria (4.1 ± 1.6 vs 5.1 ± 1.3), SLEDAI-2K score (7.7 ± 6.4 vs 9.9 ± 7.8), fewer showed positive ANA (82% vs 95%), anti-dsDNA (35% vs 67%), anti-Sm (11% vs 31%), anti-RNP (29% vs 47%), anti-Ro (34% vs 49%), low C3 or C4 (39% vs 53%), and fewer used steroids (47% vs 61%), anti-malarials (30% vs 44%), and immunosuppressants (12% vs 26%) than NS (all p < 0.03). In multivariable analyses, adjusting for age, sex, and ethnicity, smoking was independently associated with lower values of ACR criteria, ANA, anti-Sm antibodies, and abnormal C3/C4 (all 0.0001 < p < 0.05).
After one-year (n = 376) and two-years (n = 336) of follow-up, CS continued with lower frequency of positive ANA (p < 0.0001), anti-dsDNA (p < 0.001), and use of steroids (p < 0.05), anti-malarials (p < 0.0001), and immunosuppressants (p < 0.0001). The adjusted mean SLEDAI-2K at one year was lower among CS than NS (5.7 vs 6.6, p = 0.05), but not at two years (5.3 vs 5.6, p = NS), likely due to treatment.
Conclusion: Smoking status seems to be associated with differences in clinical and serological phenotype at the onset of lupus. If these results are confirmed, the underlying mechanisms need to be elucidated.
To cite this abstract in AMA style:Sanchez-Guerrero J, Al Dhaheri A, Morrison S, Su J, Gladman DD, Urowitz M. Association between Smoking Status and the Clinical and Serological Characteristics at the Onset of Systemic Lupus Erythematosus. an Inception Cohort Analysis [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/association-between-smoking-status-and-the-clinical-and-serological-characteristics-at-the-onset-of-systemic-lupus-erythematosus-an-inception-cohort-analysis/. Accessed September 20, 2021.
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