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Abstract Number: 1645

Tobacco Exposure and Relationship with Severe Damage in Systemic Lupus Erythematosus Patients

Micaela Ana Cosatti1, Sebastian Muñoz2, Natalia Tamborenea3, Mercedes Argentina García4, Ana Curti5, Ana Maria Capuccio6, Oscar Rillo7, Patricia Imamura8,9,10, Emilce Schneeberger11, Fernando Dal Pra12, Marcela Ballent13, Mario Luis Cousseau14, Jorge Velasco Zamora15, Veronica Saurit16, Sergio M.A. Toloza17,18, Maria Danielsen19, Veronica Bellomio20, Cesar Graf21, Sergio Paira22, Javier Cavallasca23, Bernado Pons-Estel24, Jose Moreno25, Monica Patricia Diaz26, Paula Alba27, Marcela Verando28, Guillermo Tate3, Eduardo Mysler29, Judith Sarano30, Emma Civit31, Fabian Risueño32, Pablo Alvarez Sepúlveda33, Maria Silvia Larroude6, Marcos Mendez34, Andrea Conforti35, Debora Sohn36, Danith Medina Bornachera37, Samanta Malm- Green38, Analia Alvarez39, Claudia Andrea Helling40, Susana Roverano41, Gisela Pendón42, M. Mayer43, Josefina Marin44, Cecilia Catoggio45, Alicia Eimon46 and Cecilia N. Pisoni47, 1Section Rheumatology and Immunology, CEMIC, CABA, Argentina, 2Rheumatology Unit, Hospital “Dr. Juan A. Fernández”, CABA, Argentina, 3OMI, Buenos Aires, Argentina, 4Rheumatology Unit, HIGA San Martín La Plata, La Plata, Argentina, 5rheumatology, Hospital de Clínicas José de San Martin, CABA, Argentina, 6Hospital Cesar Milstein, CABA, Argentina, 7Hospital Pirovano, CABA, Argentina, 8IMAI, Caba, Argentina, 9Rheumatology, Hosp Italiano de Buenos Aires, Buenos Aires, Argentina, 10Internal Medicine, Rheumatology Section, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina, 11Rheumatology Section, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina, 12Section of Rheumatology, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina, Buenos Aires, Argentina, 13Hospital RamónSantamarina, Tandil, Argentina, 14Policlínica Privada Paz, Tandil, Argentina, 15Instituto Médico CER, Quilmes, Argentina, 16Rheumatology, Hospital Privado Córdoba, Cordoba, Argentina, 17Medicine, Hospital San Juan Bautista, Catamarca, Argentina, 18Hospital San Juan Bautista, Ciudad de San Fernando del Valle de Catamarca, Argentina, 19Rheumatology, Hospital Regional, Santiago del Estero, Argentina, 20Hospital Ángel Cruz Padilla, Tucuman, Argentina, 21Centro Médico Mitre, Paraná, Argentina, 22Reumatologia, Hospital J M Cullen, Santa Fe, Argentina, 23Hospital José Bernardo Iturraspe, San Francisco, Argentina, 24GLADEL, Rosario, Santa Fe, Argentina, 25Instituto Médico CER, San Juan, Argentina, 26Centro Traumatológico Bariloche, Bariloche, Argentina, 27Universidad Nacional de Cordoba, Rheumatology Unit Cordoba and Materno Neonatal Hospital, Córdoba, Argentina, 28Hospital General de Agudos Bernardino Rivadavia, CABA, Argentina, 29Organización Médica de Investigación, Buenos Aires, Argentina, 30Rheumatology Unit, Instituto de Investigaciones Medicas Alfredo Lanari, Buenos Aires, Argentina, 31Hospital del Carmen, Godoy Cruz, Argentina, 32ITEMedica, Bahia Blanca, Argentina, 33Hospital Central de San Isidro, Buenos Aires, Argentina, 34Consultorios Pilar, Madryn, Argentina, 35OSEP Mendoza, Mendoza, Argentina, 3631Consultorio privado de reumatología, Buenos Aires, Argentina, 37Hospital Penna, CABA, Argentina, 38Hospital Bernardino Rivadavia, CABA, Argentina, 39Hospital Penna, Bahía Blanca, Argentina, 40URUGUAY 725, Omi, CABA, Argentina, 41Hospital José Maria Cullen, Santa Fe, Argentina, 42Hospital Ricardo Gutierrez, La Plata, Argentina, 43Hospital Británico, Buenos Aires, Argentina, 44Rheumatology Unit, Internal Medicine Service, Hospital Italiano de Buenos Aires, Instituto Universitario Hospital Italiano de Buenos Aires, and Fundacion PM Catoggio, Buenos Aires, Argentina, 45Rheumatology and Immunology, Rheumatology and Immunology, CEMIC, Buenos Aires, Argentina, 46CEMIC, Buenos Aires, Argentina, 47Internal Medicine, CEMIC, Rheumatology and Immunology, CEMIC, Buenos Aires, Argentina

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: systemic lupus erythematosus (SLE) and tobacco use

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Session Information

Date: Monday, November 6, 2017

Session Title: Systemic Lupus Erythematosus – Clinical Aspects and Treatment Poster II: Damage and Comorbidities

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: to assess relationship between smoking exposure and organ damage accrual measured by Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index for Systemic Lupus Erythematosus score (SLICC-SDI) in consecutive patients with systemic lupus erythematosus (SLE) from Argentina.

Methods: 623 consecutive SLE patients (fulfilling ≥4, 1997 ACR criteria) were included in this cross-sectional study. Sociodemographic and disease related variables including SLICC-SDI score and smoking status were collected.

Patients currently smoking were considered “smokers”, and “non-smokers” those who never smoked and previous smokers.

SLICC-SDI was divided into 2 categories < 3 and ≥ 3 severe damage (this cut off was previously reported in the literature).

Descriptive statistics and frequency distributions were used to describe the population studied. Chi-square was used to test differences between groups for categorical variables. Continuous variables were examined using student´s t-test and Mann-Whitney (Wilcoxon) test for non-normally distributed variables. Univariate analyses and multivariate logistic regression model were calculated.

Results:

623 patients were included in the analysis, 89% women, and median age was 38 (IQR 30-46) years. Eighty-four per cent were non-smokers and 16 % were current smokers. Fifty seven per cent were white, and 43% were non-white (mestizo and Amerindian). Seventy four per cent had >12 years of formal education.

Median disease duration was 9 years (IQR4-13). Median number ACR criteria met were 6 (IQR 5-7), mean SLICC-SDI score was 1.16 (SD 1.75) for non-smokers and 1.43 (SD 1.89) for current smokers (p 0.915).

Table 1 describes ACR criteria in smokers and non-smokers. Discoid lupus was significantly associated with smoking exposure.

SLE criteria

All patients

n:623

Non-smokers

n: 515

Current smokers

n: 108

p

Malar rash, n(%)

445 (71)

372 (71)

73 (75)

0.465

Discoid lupus, n (%)

67 (11)

51 (10)

16 (16)

0.053

Photosensivity, n (%)

432 (69)

366 (70)

66 (67)

0.641

Arthritis/ arthralgias, n(%)

529 (85)

444 (85)

85 (87)

0.610

Ulcers, n(%)

268 (43)

220 (42)

48 (49)

0.194

Neurologic, n(%)

79 (13)

64 (12)

15 (15)

0.395

Hematologic disorder, n (%)

304 (49)

254 (48)

50 (51)

0.631

Serositis, n (%)

197 (32)

170 (32)

27 (28)

0.345

Renal disease, n(%)

279 (45)

240 (46)

39 (40)

0.273

Immunologic, n(%)

454 (74)

384 (74)

72 (73)

0.90

Antinuclear antibodies, n (%)

615 (99)

517 (99)

98(99)

0.905

Eighty-three per cent of patients had SLICC-SDI <3 and 17 % had ≥ 3. In patients with SLICC-SDI ≥ 3: 21% were smokersand 15% of patients with <3 SLICC-SDI were current smokers (p 0.081).

Univariate analysis comparing demographical and clinical characteristics of both groups are described in Table 2.

All patients

N=623

SLICC<3

N= 515

SLICC≥3

N=108

p

Female, n (%)

556 (89)

461(89)

95 (88)

0.636

White race, n (%)

317 (57)

271 (58)

45 (55)

0.639

Age, years (median IQR)

38 (30-46)

36 (29-45)

43 (33-54)

<0.001

SLE ACR criteria (median IQR)

6 (5-7)

6 (5-7)

7 (6-8)

<0.001

Disease duration years (median IQR)

7 (4-13)

7 (3-12)

10 (6-16)

<0.001

Age at diagnosis, years (median IQR)

28 (21-37.5)

28 (21-36)

30 (21-37.5)

0.05

Education>12 years, n (%)

461 (74)

381 (74)

78 (72)

0.655

Current smokers, n (%)

98 (16)

77 (15)

23 (21)

0.081

Hydroxychlroquine (HCQ) , n (%)

579 (93)

479 (93)

100 (93)

0.761

Steroids, n (%)

467 (75)

386 (75)

85 (79)

0.409

Cyclophosphamide (CF), n (%)

149 (24)

103 (20)

46 (43)

< 0.01

Azathioprine (AZA), n (%)

181 (29)

134 (26)

49 (45)

< 0.01

Micofenolate mofetil, (MMF), n (%)

255 (21)

108 (21)

18 (17)

0.254

In the multiple regression analysis considering SLICC-SDI score ≥3 as dependent variable (adjusting by smoking exposure, age, sex,race, disease duration, > 12 years of education, corticosteroids, CF, AZA and HCQ exposure), we found that smoking (OR 1. 90, CI 95% 1.04- 3.46, p 0.035), age (OR 1.33, CI 95% 1.00-1.75, p 0.044), and CF exposure (OR 2.64, CI 95% 1.41-4.97, p 0.002) were associated to SLICC ≥3 .

Conclusion: Tobacco exposure, older age and cyclophosphamide use were associated to SLICC-SDI ≥3.


Disclosure: M. A. Cosatti, None; S. Muñoz, None; N. Tamborenea, None; M. A. García, None; A. Curti, None; A. M. Capuccio, None; O. Rillo, None; P. Imamura, None; E. Schneeberger, None; F. Dal Pra, None; M. Ballent, None; M. L. Cousseau, None; J. Velasco Zamora, None; V. Saurit, None; S. M. A. Toloza, None; M. Danielsen, None; V. Bellomio, None; C. Graf, None; S. Paira, None; J. Cavallasca, None; B. Pons-Estel, None; J. Moreno, None; M. P. Diaz, None; P. Alba, None; M. Verando, None; G. Tate, None; E. Mysler, None; J. Sarano, None; E. Civit, None; F. Risueño, None; P. Alvarez Sepúlveda, None; M. S. Larroude, None; M. Mendez, None; A. Conforti, None; D. Sohn, None; D. Medina Bornachera, None; S. Malm- Green, None; A. Alvarez, None; C. A. Helling, None; S. Roverano, None; G. Pendón, None; M. Mayer, None; J. Marin, None; C. Catoggio, None; A. Eimon, None; C. N. Pisoni, None.

To cite this abstract in AMA style:

Cosatti MA, Muñoz S, Tamborenea N, García MA, Curti A, Capuccio AM, Rillo O, Imamura P, Schneeberger E, Dal Pra F, Ballent M, Cousseau ML, Velasco Zamora J, Saurit V, Toloza SMA, Danielsen M, Bellomio V, Graf C, Paira S, Cavallasca J, Pons-Estel B, Moreno J, Diaz MP, Alba P, Verando M, Tate G, Mysler E, Sarano J, Civit E, Risueño F, Alvarez Sepúlveda P, Larroude MS, Mendez M, Conforti A, Sohn D, Medina Bornachera D, Malm- Green S, Alvarez A, Helling CA, Roverano S, Pendón G, Mayer M, Marin J, Catoggio C, Eimon A, Pisoni CN. Tobacco Exposure and Relationship with Severe Damage in Systemic Lupus Erythematosus Patients [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/tobacco-exposure-and-relationship-with-severe-damage-in-systemic-lupus-erythematosus-patients/. Accessed January 20, 2021.
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