Background/Purpose: The influence of smoking on the development of rheumatoid arthritis, the severity of the disease and the response to treatment is well established. The impact of tobacco use in patients with axial spondyloarthritis (axSpA) is only beginning to emerge. The aim of our study was to review the literature to evaluate the impact of tobacco on the development of axSpA, the activity and the severity of the disease and the therapeutic  response.

Methods: Using PUBMED database, COCHRANE and a manual search, we review the literature with the keywords: “Spondylarthropathies”[Mesh] OR “spondylitis”[Mesh] OR “spondylitis, ankylosing “[Mesh] OR “spondylarthropathy” OR spondylitis OR spondylarthropathies) AND (tobacco OR “tobacco”[Mesh] OR smoking OR “smoking”[Mesh] OR “cigarette” OR “environmental” OR “environmental factors”. The articles on psoriatic arthritis were excluded. Smoking status was divided into current smoker (CS), past smoker (PS), never smokers (NS), ever smoker (ES) with ES=CS + PS, and non-smokers= PS + NS.

Results: Among 511 articles  (493 from PUBMED, 17 from COCHRANE and one from the manual search), we include 15 articles  (2 abstracts from congress). No significant difference was found between ES and NS in terms of age at symptoms onset (-0.67 [-3.18 to 1.83]; I² = 47%; p=0,60, n=2), on erythrocyte sedimentation rate (ESR) (+2,87 [-7.73 to13.46]; I² = 85%; p=0.60; n=2), on C-reactive protein (CRP) (+3.12 [-2.3 to 8.55]; I² = 89%; p=0.26; n=3), on BASDAI (+0.16 [-0.05 to 0.37]; I² = 12%; p=0.14; n=3), and on HAQ (0.0 [-0.2- 0.2]; I² = 83%; p=1.0; n=2). Conversely, BASFI (+0.69 [0.44 to 0.93]; I² = 0%; p<0.001; n=3) and ASDAS-CRP was higher in ES versus NS (+0.14 [0.03to 0.25]; I² = 0%; p=0.01; n=2).  Comparing CS to non-smokers, we found a trend to increased CRP (+2.74 [-0. 44 to 5.93]; I² = 0%; p=0.09; n=3) and BASDAI  (+ 0.48 [-0.07to1.03]; I² = 84%; p=0.08; n=5) and a significant increase of BASFI in (+1 [0.35 to 1,66]; I² = 74%; p=0.003; n=5).The systematic review of literature showed that ES had higher inflammation on MRI and axial structural damage on MRI and radiographs than NS. Response to tumour necrosis factor-alpha inhibitor treatment evaluated by BASDAI 50% at 6 and 12 months was decreased in ES compared to NS.

Conclusion: Current and past smocking is associated with an increased disease activity (BASDAI and ASDAS-CRP respectively) and functional impairment. Pathogenesis remains to be determined. Smoking cessation should be encouraged in axSpA although these results suggest that it may not impact disease prognosis.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/current-and-past-smoking-are-associated-with-functional-impairement-and-increased-disease-activity-in-axial-spondyloarthritis-systematic-review-and-meta-analysis/