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Abstract Number: 2014

Cigarette Smoking and Male Sex Are Independent Risk Factors For Ocular Sarcoidosis

Adam Janot1, Dörte Huscher2, McCall Walker3, Harmanjot K. Grewal4, Mary Yu1, Matthew R. Lammi5,6 and Lesley Ann Saketkoo7,8, 1Internal Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, 2German Rheumatism Research Centre and Charité University Medicine, Berlin, Germany, 3LSUHSC School of Medicine, New Orleans, LA, 4Rheumatology, Lousiana State University Health Sciences Center, New Orleans, LA, 5Section of Pulmonary and Critical Care Medicine, LSU Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, LA, 6Louisiana State University Health Sciences Center, Pulmonary and Critical Medicine, New Orleans, LA, 7LSU Scleroderma and Sarcoidosis Patient Care and Research Center, New Orleans, LA, 8Scleroderma and Sarcoidosis Patient Care and Research Center, Rheumatology and Pulmonary Medicine, Louisiana State University Health Sciences Center, New Orleans, LA

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: ocular involvement, sarcoidosis, sex bias, tobacco use and uveitis

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Session Information

Title: Miscellaneous Rheumatic and Inflammatory Diseases II: Miscellaneous Rheumatic Diseases

Session Type: Abstract Submissions (ACR)

Background/Purpose: Sarcoidosis is a multi-organ system granulomatous disease of unknown origin with an incidence of 1-40/100,000.  Though pulmonary manifestations are predominant, ocular morbidity is characteristic.  Ocular Sarcoidosis (OS) affects 25-50% of patients with sarcoidosis and can lead to blindness. To date, no studies have sought to determine risk factors for OS.

Methods: A retrospective chart review was conducted at a single institution with inclusion criteria of biopsy-proven sarcoidosis with a duration of >1 year and a documented smoking status. Variables collected were ages at time of diagnosis (of any organ) and at time of chart review, race, sex, smoking status, quantity of tobacco exposure, and presence (or history) of OS.  Disease duration is defined as the difference of age at diagnosis and age time of chart review.  Group comparisons were done by t-test and by Mann-Whitney tests where applicable. Univariate and multivariate regression analysis were done to identify independent risk factors.

Results: Of 269 charts reviewed, 109 patients met inclusion criteria.  Characteristics of patients with and without OS are shown in table 1. In the OS group, the portion of smokers (71.4%) was significantly higher than in the group without OS (42.0%, p=0.027). There was no significant difference (p=0.605) in the median number of pack years between smokers with OS (13 [7, 28]) and those without OS (16.5 [7, 25]).  Furthermore, the OS group consisted of more male patients (57.1% versus 26.1%, p=0.009).  Median disease duration of sarcoidosis was also higher in patients with OS (10 years versus 4 years, p=0.031).

Through multivariate regression analysis, tobacco exposure (OR=5.24, p=0.007, 95% CI 1.58-17.41) and male sex (OR=7.48, p=0.002, 95% CI 2.152-26.006) were found to be independent risk factors for the development of OS.   

Conclusion: Male sex and tobacco exposure (regardless of pack years) are independent risk factors for development of OS.  Disease duration did not withstand multivariate analysis in this moderately sized group. However, screening for OS should not remit in patients with known sarcoidosis until defined in larger prospective populations.

Table 1: Characteristics of patients with and without OS

No OS (n=88)

With OS (n=21)

p-value

Sex

Female

65

(73.9%)

9

(42.9%)

0.009

Male

23

(26.1%)

12

(57.1%)

Age at onset of sarcoidosis (median, IQR)

41

(35, 49)

43

(33, 49)

0.863

Disease duration (median, IQR)

4

(2, 12)

10

(4,15)

0.031

Race

Black

78

(88.6%)

19

(90.5%)

1.000

 (black vs. all other)

White

5

(5.7%)

0

Hispanic

0

1

(4.8%)

Middle Eastern

1

(1.1%)

0

(0.0%)

Unknown

4

(4.5%)

1

(4.8%)

Smoking Status

Never smoker

51

(58.0%)

6

(28.6%)

0.027

Ever smoker

37

(42.0%)

15

(71.4%)

Pack years of ever smokers (median; IQR)

13

(7, 28)

16.5

(7, 25)

0.605


Disclosure:

A. Janot,
None;

D. Huscher,
None;

M. Walker,
None;

H. K. Grewal,
None;

M. Yu,
None;

M. R. Lammi,
None;

L. A. Saketkoo,
None.

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