Association of African- American Ethnicity and Smoking Status and Total and Individual Damage Index in Systemic Lupus Erythematosus

Romy Kallas¹, Jessica Li ¹ and Michelle Petri ¹, ¹Johns Hopkins University School of Medicine, Baltimore, MD

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: modifiable risk and African-Americans, Systemic lupus erythematosus (SLE)

Session Information

Date: Monday, November 11, 2019

Title: SLE – Clinical Poster II: Comorbidities

Session Type: Poster Session (Monday)

Session Time: 9:00AM-11:00AM

Background/Purpose: Smoking and African- American ethnicity are risk factors for systemic lupus erythematosus (SLE). Smoking has been associated with increased prevalence of SLE, increased disease activity and decreased effectiveness of hydroxychloroquine in cutaneous lupus. The objective of the study was to determine the association between smoking status and total damage, as well as individual damage items, in SLE by ethnicity.

Methods: We analyzed data from a longitudinal Lupus Cohort. Damage was recorded using the Systemic Lupus Erythematosus International Collaborating Clinics/ American College of Rheumatology (SLICC/ACR) Damage Index. Poisson regression was used to model the total damage score against ever smoking. Cox regression was used to assess the relationship between time to damage items and ever smoking, stratified by ethnicity. Adjusted hazard ratios (HR) and 95% confidence intervals were reported. For each damage item, patients who had a damage diagnosis prior to or at the date of SLE diagnosis were excluded in the analysis.

Results: The study included 2629 patients. The prevalence of ever smokers was 35.8%. There was no significant difference in total damage score between eve smokers and never smokers after adjustment. Table 1 summarizes the Damage Index findings.

Ever smokers had more atherosclerotic cardiovascular (angina, coronary bypass, myocardial infarction and claudication) damage and skin damage compared to non-smokers. Caucasian SLE patients who ever smoked were more likely to have muscle atrophy. African- American patients who ever smoked were more likely to have any skin damage.

Conclusion: Smoking is a modifiable factor for organ damage in SLE. Our analysis proved the major effect was on cardiovascular damage (angina, coronary bypass, myocardial infarction and claudication). Surprisingly, these cardiovascular damage items have higher hazard ratios in Caucasian smokers. Smoking also increased some skin damage items. These skin damage items hazard ratios were higher in African-Americans.

Abstract- ACR 2019-RomyKallas-Table1

Table 1 – Adjusted Associations Between Damage Index Items and Smoking Status

Disclosure: R. Kallas, None; J. Li, None; M. Petri, Eli Lilly and Company, 5, Exagen, 2, 5.

To cite this abstract in AMA style:

Kallas R, Li J, Petri M. Association of African- American Ethnicity and Smoking Status and Total and Individual Damage Index in Systemic Lupus Erythematosus [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/association-of-african-american-ethnicity-and-smoking-status-and-total-and-individual-damage-index-in-systemic-lupus-erythematosus/. Accessed .

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