Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Analysis of data from several cohort studies of patients with ankylosing spondylitis (AS) /axial spondyloarthritis (AxSpA) have confirmed earlier suggestions that current smokers have worse outcomes in relation to disease activity, quality of life, radiographic progression and response to biologic therapies. To date studies have not used pack years to assess if there is a dose related effect. The effect of smoking on quality of life has only been studied in a cross sectional analysis.
The aim of the current study was to investigate the effect of smoking on disease activity and quality of life in patients with AxSpA and determine if continued smoking worsens outcomes over time.
The Spondyloarthritis Genetics and the Environment (SAGE) study is a longitudinal multicenter study established in 2010 in New Zealand. Annual assessments were performed on a total of 368 patients fulfilling the ASAS criteria for AxSpA. A smoking history, including pack years, was obtained by interview from all participants. Standard outcome measures were recorded at each annual visit including BASDAI, BASFI, AS disease activity score (ASDAS-CRP) and quality of life measures both generic (EuroQol) and specific to AS (ASQol). The association between smoking and outcomes was assessed by linear regression analysis (statistical program R).
At baseline (visit 1) complete smoking data was available for 361 participants: 189 (52%) had never smoked, 117 (33%) were previous smokers and 55 (15%) were current smokers which is similar to national population data for current smokers in New Zealand (17%).
At baseline, there was a significant association between current cigarette smoking, and worse disease activity and physical function (ASDAS-CRP β=0.95, 95% P=0.018, BASDAI β=0.95 95% P=0.012, BASFI β=1.19, 95% P=0.0032).
There was a linear relationship between quantity smoked (recorded as pack years/age) and higher CRP: β 0.59 P=0.047.
After 12 months (visit 2), complete smoking data were available for 191 participants: 97 had never smoked, 71 were previous smokers, and 23 were current smokers. At visit 2, there was a significant association between cigarette smoking and higher disease activity as measured by the ASDAS-CRP (β=0.60, 95% P=0.0097). This remained significant even after adjusting for ASDAS-CRP at baseline (P<0.05).
Quality of life (Qol) measures showed that current smokers compared to those who never smoked had significantly worse health related Qol: ASQol β 3.35 P = 6.66e-05, EuroQol β -0.189 [-0.28- -0.097] P = 6.02e-05. At one year of follow up current smokers continued to record worse Qol measured by EuroQol: -0.12 [-0.22- -0.028] P = 0.012.
Smoking is associated with higher disease activity and worse quality of life at baseline. After one year of follow up these differences persist. Furthermore, there is a linear relationship between amount smoked and CRP, a marker for worse outcome. Patients with AS/AxSpA should be encouraged to quit smoking.
To cite this abstract in AMA style:Stebbings S, Wallace M, Harrison AA, Dalbeth N, White D, Stamp LK, Ching D, Highton J. In Ankylosing Spondylitis/Axial Spondyloarthritis Smoking Is Associated with a Dose Related Elevation in CRP, Worse Disease Activity and Worse Quality of Life over One Year [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/in-ankylosing-spondylitisaxial-spondyloarthritis-smoking-is-associated-with-a-dose-related-elevation-in-crp-worse-disease-activity-and-worse-quality-of-life-over-one-year/. Accessed December 1, 2022.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/in-ankylosing-spondylitisaxial-spondyloarthritis-smoking-is-associated-with-a-dose-related-elevation-in-crp-worse-disease-activity-and-worse-quality-of-life-over-one-year/