Session Information
Session Type: ARHP Concurrent Abstract Session
Session Time: 4:30PM-6:00PM
Background/Purpose: Smoking appears to be associated both with an increased risk of rheumatoid arthritis and with more severe symptoms. The impact of smoking on patient-reported disease status and symptoms in lupus has not been reported.
Methods: Data were from the National Data Bank for Rheumatic Diseases (NDB), for which participants complete questionnaires every 6 months. Only women with lupus who responded to at least one of the two most recent completed questionnaires were included (n = 481). Self-reported lupus status was assessed with the Systemic Lupus Activity Questionnaire (SLAQ)1, the Brief Inventory of Lupus Damage (BILD)2, global assessment of health status (rating from 0 [doing very well] – 10 [doing very poorly]), and assessment of lupus activity (rating from 0 [not active] – 10 [very active]). Patient-reported symptoms were assessments of pain, fatigue, and sleep problems, each rated 0 – 10 with higher ratings reflecting worse symptoms, and depressive symptoms assessed with the PHQ-8. Bivariate and multivariate linear regression analyses estimated the relationship of current and former smoking on outcomes. Multivariate analyses controlled for age, low education, Medicaid or no health insurance, number of rheumatology visits, duration of lupus, obesity, Rheumatic Disease Comorbidity Index (RDCI)3, and prednisone use.
Results: Mean age was 58 ± 13 years, 22% had education ≤ high school, and 15% had Medicaid or no health insurance. Mean disease duration was 21 ± 12 years, 34% were obese, and mean score on the RDCI was 2.7 ± 1.8. Means of each lupus status and symptom measure are shown in the Table. Six percent were current smokers, 31% were former smokers, and 63% had never smoked. In unadjusted analyses, current smokers had significantly worse scores than never smokers on all measures except the BILD (Table), and former smokers had worse scores on the SLAQ and ratings of lupus activity. After adjustment, the elevated scores of current smokers compared with never smokers remained for all measures except the BILD.
Conclusion: While current smoking was not common, it was associated with significantly worse patient assessments of lupus status and worse symptoms. Findings underscore the importance of assessing smoking and supporting smoking cessation efforts among women with lupus.
1 Karlson EW, et al. Lupus 2003; 12:280.
2 Yazdany J, et al. Arthritis Care Res 2011; 63:1170
3 England BR, et al. Arthritis Care Res 2015; 6: 865
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Table. Association of current and former smoking with patient-reported lupus status and symptoms |
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|
Overall mean ± SD |
Smoking |
Unadjusted* |
Adjusted* |
|
Global assessment of lupus (0 – 10 rating, higher score worse) |
4.12 ± 2.57 |
Current Former Never |
5.77 (.003) 4.08 (.22) 3.70 (ref) |
5.55 (.004) 3.98 (.35) 3.75 (ref) |
|
Lupus disease activity (Systemic Lupus Activity Questionnaire; SLAQ) |
11.05 ± 7.14 |
Current Former Never |
17.13 (.006) 12.26 (.03) 10.06 (ref) |
16.89 (.004) 11.80 (.17) 10.25 (ref) |
|
Lupus disease damage (Brief Inventory of Lupus Damage; BILD) |
3.32 ± 2.08 |
Current Former Never |
4.00 (.25) 3.65 (.09) 3.14 (ref) |
3.79 (.21) 3.38 (.69) 3.27 (ref) |
|
Lupus activity (0 – 100 rating, higher score worse) |
30.04 ± 27.45 |
Current Former Never |
52.50 (.009) 35.92 (.02) 26.74 (ref) |
50.54 (.01) 34.84 (.09) 27.25 (ref) |
|
Pain (0 – 10 rating, higher score worse) |
4.30 ± 2.99 |
Current Former Never |
6.04 (.01) 4.13 (.51) 3.90 (ref) |
5.80 (.02) 4.08 (.82) 3.95 (ref) |
|
Fatigue (0 – 10 rating, higher score worse) |
5.15 ± 3.13 |
Current Former Never |
6.85 (.03) 4.95 (.95) 4.93 (ref) |
6.67 (.03) 5.01 (.82) 4.91 (ref) |
|
Sleep problems (0 – 10 rating, higher score worse) |
4.35 ± 3.21 |
Current Former Never |
7.62 (<.0001) 4.35 (.49) 4.08 (ref) |
7.38 (.0002) 4.36 (.42) 4.08 (ref) |
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Depressive symptoms (PHQ8) |
5.92 ± 5.39 |
Current Former Never |
11.12 (.003) 6.54 (.12) 5.38 (ref) |
10.99 (.002) 6.41 (.24) 5.45 (ref) |
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* Unadjusted and adjusted means (p-values) calculated from linear regression analyses. Multivariate analyses controlled for age, duration of lupus, low education, Medicaid or no insurance, obesity, comorbidities, prednisone use, and number of rheumatologist visits, comparing current and former smokers to never smokers. |
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To cite this abstract in AMA style:
Katz PP, Chakravarty E, Katz RS, Michaud K. Impact of Smoking on Patient-Reported Disease Status and Symptoms Among Women with Lupus [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/impact-of-smoking-on-patient-reported-disease-status-and-symptoms-among-women-with-lupus/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/impact-of-smoking-on-patient-reported-disease-status-and-symptoms-among-women-with-lupus/