Background/Purpose: Ankylosing spondylitis (AS) is a systemic disease characterized by sacroiliitis and inflammatory back pain. The radiological findings of AS appear late causing delay in diagnosis, therefore axial spondyloarthritis (axSpA) which includes AS and nonradiographic axSpA (nr-axSpA) have been defined.

The objective of this study is to identify the potential impacts of smoking on disease activity markers, physical examination and laboratory findings in severe AS and nr-axSpA receiving anti-tnf therapy.

Methods: In this study, 211 patients treated with Anti-TNF diagnosed as axSpA based on ASAS criteria ( of which 142 AS according to modified New York criteria and 69 as nr-axSpA ) between 2000 and 2013 were included. Patients were evaluated retrospectively. Smoking intensity has been evaluated as per pack-year. Patients were separated into groups according to smoking habits and intensity. Acute phase reactants and functional indexes – erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Bath AS Metrology Index (BASMI), Bath AS Functional Index (BASFI), Bath AS Disease Activity Index (BASDAI) and AS Quality of Life (ASQoL)- were compared between groups.  Physical examination including Schober’s test (ST), chest expansion (CE), fingertip-to-floor distance (FFD), tragus wall distance (TWD), lateral lumbar flexion (LLF), cervical rotation (CR), occiput-to-wall distance (OWD), inter-malleolar distance (IMD), chin-sternum distance (CSD) was performed. Independent sample t, paired t test, one-way Anova were used to compare values.

Results: Based on comparison betweeen smokers (n:121) and non-smokers (n:90), physical mobility indicators ST (p:0.03), FFD (p<0.001) and LLF (p: 0.035) were found significantly more restricted in smokers and BASDAI (p: 0.011) values were significantly improved after anti-TNFα treatment in non-smokers. If smoking period is >20 years, LLF (p:0.004), CR (p:0.004), CE (p:0.005), OWD (p:0.021), TWD (p: 0.001), IMD (p: 0.015), BASFI (p: 0.019) and BASMI (p< 0.001) were significantly deteriorated. When effects of smoking were evaluated between AS (n:142) and nr-axSpA (n: 69) groups, significant restriction of ST (p:0.04) and FFD (p<0.001) in AS group within smokers, restriction of FFD (p:0.02), CR( p:0.04), OWD (p:0.02), TWD (p:0.003), CSD (p: 0.02) and LLF (p:0.002) in AS group among smokers >10 years or more and significant restriction of ST (p: 0.04), FFD (p<0.001), LLF (p: 0.01) in AS group who had quit smoking compared to non-smokers were found. Among currently smoking patients (n:46) comparison between who smoke >20 pack-year (n:23) and who smoke <20 pack-year  (n:46) showed significant deterioration of ST (p: 0.007), CR (p:0.01), CE (p:0.002), TWD (p:0.01), IMM (p: 0.007), BASFI (p: 0.004), BASDAI (p:0.005), BASMI (p: 0.005) and ASQoL (p:0.04)  only  in nr-axSpA  group.

Conclusion: Our study showed that smoking and especially heavy smoking had negative effects on all stages of axSpA. In nr-axSpA, considered as early axSpA, to quit smoking would be more important  for  significant differences were seen in spinal mobility, functional situation, disease activity and quality of life in this group of patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/effects-of-smoking-in-patients-with-axial-spondyloarthritis-ankylosing-spondylitis-and-nonradiographic-axial-spondyloarthritis-receiving-anti-tnf-therapy/