Tobacco Differentially Affects the Clinical-Biological Phenotype of ANCA-Associated Vasculitides at Diagnosis

Lucas Benarous¹, Benjamin Terrier², Bertrand Dunogué³, Pascal Cohen⁴, Xavier Puéchal⁴, Claire Le Jeunne⁴, Luc Mouthon⁴ and Loïc Guillevin for the French Vasculitis Study Group⁴, ¹Cochin Hospital, Paris, France, ²National Referral Center for Rare Systemic Autoimmune Diseases, Cochin Hospital, Paris, France, ³Internal Medicine, Hôpital Cochin, Paris, France, ⁴National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, AP–HP, Université Paris Descartes, Paris, Paris, France

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: Churg-Strauss syndrome, tobacco use and vasculitis, Wegener's granulomatosis

Session Information

Session Title: Vasculitis

Session Type: Abstract Submissions (ACR)

Background/Purpose

Occupational and non-occupational exposures may play a role in the occurrence of ANCA-associated vasculitides (AAV) and affect their initial clinical-biological phenotype. Among these potential exposures, tobacco use could represent a factor that could influence AAV characteristics at diagnosis. However, these effects could differ according to the type of AAV, since granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA) and eosinophilic granulomatosis with polyangiitis (EGPA) involve different pathophysiological mechanisms.

Methods

AAV patients entered in the FVSG database with available information on previous and current smoking habits were analyzed. The clinical-biological phenotype at diagnosis was compared according to current tobacco use (current smokers) or not (including previous and never smokers).

Results

This analysis concerned 1165 patients (545 men and 620 women; mean age of 52.8±16.1 years). AAV diagnoses were: GPA for 583 (50%), MPA for 256 (22%) and EGPA for 326 (28%). Among them, 973 patients (84%) were never smokers, 116 (10%) were previous smokers and 76 (6%) were current smokers. Among GPA patients, current smokers (n=55), compared to non-current smokers (n=528) respectively, were younger (44.5±13.5 vs. 52.0±16.3, P=0.0001), more frequently men (64 vs. 48%, P=0.016) and had more frequent cutaneous involvement (50 vs. 32%, P=0.025), and tended to have more frequent arthralgias (67 vs. 54%, P=0.11) and less frequent constitutional symptoms (33 vs. 47%, P=0.08) and ear, nose & throat (ENT) involvement (73 vs. 83%, P=0.13). BVAS, PR3-ANCA–positivity and inflammatory parameters were similar for the 2 groups. Among EGPA patients, current smokers (n=15), compared to non-current smokers (n=311) respectively, were also younger (41.1±15.8 vs. 50.3±15.2, P=0.028) and had less frequent constitutional symptoms (29 vs. 62%, P=0.02), arthralgias (7 vs. 35%, P=0.04), renal involvement (0 vs. 26%, P=0.025) and MPO-ANCA–positivity (0 vs 30%, P=0.02). BVAS and inflammatory parameters were comparable for the 2 groups. Finally, analysis of MPA patients was impossible because only 6 (2%) were current smokers.

Conclusion

These results suggest that tobacco use could differentially affect GPA and EGPA clinical-biological phenotypes, while no conclusion can be drawn for MPA. Moreover, they support the role of environmental exposures in AAV development and its phenotype.

Disclosure:

L. Benarous,
None;

B. Terrier,
None;

B. Dunogué,
None;

P. Cohen,
None;

X. Puéchal,
None;

C. Le Jeunne,
None;

L. Mouthon,
None;

L. Guillevin for the French Vasculitis Study Group,
None.

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