Session Type: Abstract Submissions (ACR)
Cigarette smoking is associated with functional impairment [1, 2] and radiographic severity of ankylosing spondylitis (AS) [3, 4]. Moreover, smoking status at baseline was found recently to be an independent predictor of radiographic spinal progression in the whole group of axial spondyloarthritis (SpA) . However, the nature of relationship between smoking and radiographic spinal progression in SpA remains unclear.
The objective of the current analysis was to investigate a relationship between smoking intensity, radiographic spinal progression and activity of systemic inflammation in patients with axial SpA.
In total, 210 patients with axial SpA (115 with AS according to the modified New York criteria and 95 with nrSpA) from the German Spondyloarthritis Inception Cohort (GESPIC) were selected for this analysis of spinal radiographs at baseline and after 2 years of follow-up. Spinal radiographs were centrally collected, digitized, and subsequently scored according to the mSASSS independently by two trained readers, who were blinded for time point and all clinical data. Smoking status and smoking intensity (non-smoker, 10 cigarettes a day and less, 11 to 20 cigarettes, and more than 20 cigarettes a day) were assessed retrospectively every 6 months during 2 years of follow-up.
139 patients (66.2%) were considered to be non-smokers throughout the entire follow-up period of 2 years, 43 patients (20.5%) smoked 10 cigarettes a day and less (as a mean over two years), 22 patients (10.5%) smoked 11-20 cigarettes and only 6 patients (2.9%) smoked more than 20 cigarettes a day and, therefore, were pooled with the group of 11-20 cigarettes a day. The mean mSASSS change over 2 years was 0.52±1.72 in non-smokers vs 0.47±1.48 in a ≤10 cigarettes/day group (p=0.30) vs 2.2±4.6 in >10 cigarettes/day group (p=0.077 vs. non-smokers, p=0.35 vs. ≤10 cigarettes/day group). Significant radiographic progression (defined as an mSASSS worsening by 2 units and more over 2 years) was observed in 10.1% of non-smokers vs 18.6% in in smokers of ≤10 cigarettes a day (p=0.14 vs non-smokers) vs 28.6% in smokers of >10 cigarettes a day (p=0.012 versus non-smokers). Importantly, the same trend was observed for the serum level of C-reactive protein as a marker of inflammatory activity: 6.3±6.6 mg/l in non-smokers vs 8.6±10.3 mg/l in smokers of ≤10 cigarettes a day vs 12.4±12.9 in smokers of >10 cigarettes a day (p=0.021 vs non-smokers).
Tobacco smoking has a clear dose-dependent effect on radiographic spinal progression in axial SpA, which is likely to be related to a non-specific augmentation of inflammation by the components of the tobacco smoke.
1. Ward MM, et al. Arthritis Rheum 2005;53:710-7.
2. Mattey DL, et al. J Rheumatol 2011;38:2608-15.
3. Ward MM, et al. Arthritis Rheum 2009;61:859-66.
4. Chung HY, et al. Ann Rheum Dis 2012;71:809-16.
5. Poddubnyy D, et al. Arthritis Rheum 2012;64:1388-98.
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