Current Smoking Status Increases the Risk of Axial Psoriatic Arthritis: An Explanation to Smoking Paradox

Dilek Solmaz ¹, Umut Kalyoncu ², Ilaria Tinazzi ³, Sibel Bakirci ⁴, Ozun Bayindir ⁵, Atalay Dogru ⁶, Ediz Dalkılıç ⁷, Gezmiş Kimyon ⁸, Cem Ozisler ⁹, Gozde Cetin ¹⁰, Levent Kilic ¹¹, Ahmet Omma ¹², Meryem Can ¹³, Sema Yılmaz ¹⁴, Abdulsamet Erden ¹⁵ and Sibel Zehra Aydin¹⁶, ¹Izmir Katip Celebi University, Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, İzmir, Turkey, ²Hacettepe University Department of Rheumatology, Ankara, Turkey, ³Sacro Cuore Don Calabria Hospital, Unit of Rheumatology, Verona, Italy, ⁴Antalya Education and Research Hospital, Antalya, Turkey, ⁵Ege University, Department of Internal Medicine, Division of Rheumatology, Izmir, Turkey, ⁶Suleyman Demirel University, Department of Internal Medicine, Division of Rheumatology, Isparta, Turkey, ⁷Uludağ University, Bursa, Turkey, ⁸Mustafa Kemal University, Hatay, Turkey, ⁹Diskapi Yildirim Beyazit Education and Research Hospital, Department of Internal Medicine, Division of Rheumatology, Ankara, ¹⁰Kahramanmaras Sutcu Imam University, Department of Internal Medicine, Division of Rheumatology, Kahramanmaras, ¹¹Hacettepe University, Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Ankara, Turkey, ¹²Ankara Numune Education and Research Hospital, Department of Internal Medicine, Division of Rheumatology, Ankara, Turkey, ¹³Marmara University, Division of Rheumatology, Istanbul, Turkey, Istanbul, Turkey, ¹⁴Division of Rheumatology, Selcuk University School of Medicine, Konya, Turkey, Konya, Turkey, ¹⁵Hacettepe University, Ankara, Turkey, ¹⁶University of Ottawa Faculty of Medicine, Rheumatology,Ottawa Hospital Research Institute, 1967 Riverside Drive, Ottawa, ON, K1H 7W9, CANADA, Ottawa, Canada

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: Psoriatic arthritis, radiography and axial spondyloarthritis

Session Information

Date: Tuesday, November 12, 2019

Title: Spondyloarthritis Including Psoriatic Arthritis – Clinical Poster III: Psoriatic Arthritis, Clinical Features

Session Type: Poster Session (Tuesday)

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

Background/Purpose: Smoking has been shown to be associated with an increased risk of psoriatic arthritis (PsA) in the general population, but there are controversies among patients with psoriasis. We hypothesize that smoking is a risk factor for axial PsA specifically, similar to axial spondyloarthritis, more than the other PsA phenotypes.

Methods: PsArt-ID (Psoriatic Arthritis- International Database)] is a multicenter, international database, investigating the disease characteristics in real life. From that registry, 1535 PsA patients with smoking data were included for this analysis. Smoking status was categorized as never, current smoker or ex-smoker. Axial PsA was based on the clinicians’ judgement, requiring clinical features but not mandating any imaging. In addition grading of sacroiliitis was done by a central reader, whenever available. The effect of smoking, as well as other potential predictor factors on axial PsA and radiographic sacroiliitis, was assessed using a logistic regression analysis.

Results: Axial PsA was more common across current smokers compared to ex and non-smokers (38.9% vs 27.2% vs 26.8%, respectively; p< 0.001). Multivariate analysis to predict axial PsA showed that younger age [Odds ratio (OR)=0.98, 95% Confidence Interval (CI)= 0.97-0.99, p=0.014], male gender (OR=1.49, 95% CI=1.17-1.89, p=0.001), current smoking status (OR=1.42, 95% CI=1.07-1.88, p=0.014) and presence of nail disease (OR=1.43, 95% CI=1.14-1.80, p=0.002) were significant predictors for axPsA whereas polyarticular (OR=0.71, 95% CI=0.56-0.89, p=0.003) and distal joint involvement (OR=0.56, 95% CI=0.40-0.80 p=0.001) were protective (Table 1). Current smoking status was also found a significant predictor for radiographic sacroiliitis (OR=13.6, 95% CI= 2.87-64.6, p=0.001) (Table 2).

Conclusion: Current smoking is a significant risk factor for both axial PsA and radiographic sacroiliitis in patients with PsA, and not the peripheral phenotypes.

Table 1

Table 1. Multivariate analysis on factors associated with axial psoriatic arthritis

Table 2

Table 2.Multivariate analysis on factors associated with radiographic sacroiliitis

Disclosure: D. Solmaz, None; U. Kalyoncu, UCB, 5; I. Tinazzi, None; S. Bakirci, None; O. Bayindir, None; A. Dogru, None; E. Dalkılıç, None; G. Kimyon, None; C. Ozisler, None; G. Cetin, None; L. Kilic, None; A. Omma, None; M. Can, None; S. Yılmaz, None; A. Erden, None; S. Aydin, None.

To cite this abstract in AMA style:

Solmaz D, Kalyoncu U, Tinazzi I, Bakirci S, Bayindir O, Dogru A, Dalkılıç E, Kimyon G, Ozisler C, Cetin G, Kilic L, Omma A, Can M, Yılmaz S, Erden A, Aydin S. Current Smoking Status Increases the Risk of Axial Psoriatic Arthritis: An Explanation to Smoking Paradox [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/current-smoking-status-increases-the-risk-of-axial-psoriatic-arthritis-an-explanation-to-smoking-paradox/. Accessed .

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