Background/Purpose: Only a few studies have analyzed the influence of tobacco smoking in SLE in a quantitative way. Furthermore, scanty information exists regarding smoking and damage in SLE patients, considering the damage by organs, in a separate manner. The objective of this study was to carry out a cross-sectional analysis of the smoking habit in a well characterized, monocentric, cohort and to analyze the influence of tobacco on SLE phenotype, activity and specific damage. Additionally, we inquired about the degree of patient weakness regarding the impact of the tobacco use in SLE.

Methods: Consecutive SLE-patients (ACR-97 criteria) attendant our Lupus clinic throughout 2017 were included. At the time of the last visit, activity (S SLEDAI), cumulative clinical data and comorbidities were retrospectively collected and damage (SLICC/ACR damage index (SLICC/ACR DI) was calculated. To determine patients’ smoking exposure, we used a standard model questionnaire and the pack-year (PY) was calculated. Patients ever smoking versus never smoking were compared, using only cumulative variables. A regression model was built to identify factors associated with retinal damage

Results: 216 patients included. Mean age 49 years (±12,7), 93% females, median disease duration of 17 years (p25-p75: 9-25). 53% of the patients recognized to having ever smoked and 23% were active smokers. Medium PY: 13 (6-20.5). Sixty-one percent of all patients recalled being informed of the negative effects of smoking on their disease. However, only 54.8% of current smokers admitted to having been informed, compared to 83.3% of non-smokers (<0.001). In the bivariant analysis, an statistically significative association between tobacco any time and discoid lupus [p=0.002; OR:3,5(IC95% 1.5-8.9)] and photosensitivity [p=0.01; OR:2,06(IC95% 1.16-3.7)] was found. Regarding SDI, a trend was identified (p=0.08) with a significative association with retinal damage, adjusted by age (OR 1.03, CI95% 1-1.07, p=0.04) when the comparation was made considering the SDI organ by organ. Regarding comorbidity, the only one significative association that we found was peripheral arteriopathy (p=0.007). When the comparation was carried out using PY, a statistically significative association was found with global SDI > 0 (p=0.002) and retinal damage (p=0.02), as well as with discoid lupus (p=0.01), photosensitivity (p=0.03) and peripheral arteriopathy (p=0.01), suggesting a dose-response relationship. In a multivariate analysis exploring factors associated to retinal damage, just smoking ever and SDI remain statistically significant.

Conclusion: Smoking is associated to cutaneous manifestations and damage in SLE patients as well as peripheral arteriopathy, with a dose-response relationship. There is a specific association, not previously reported, between retinal damage and smoking. If confirmed, this association should be considered when planning the ophthalmologic monitoring for antimalarials use. It is imperative to optimize the patient education about the impact of tobacco consume in SLE.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/tobacco-and-systemic-lupus-erythematosus-relationships-pay-attention-to-the-retina/