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Abstract Number: 1313

Tobacco Exposure Is Associated With Radiographic Damage In Hispanic and African American Rheumatoid Arthritis Patients

Rodolfo Perez Alamino1, Luis R. Espinoza2, Gail S. Kerr3, Christopher Swearingen4, Chunqiao Luo5, Yusuf Yazici6, Yvonne R. S. Sherrer7, Edward L. Treadwell8, Angelia D. Mosley-Williams9, Sharon Dowell10, Ignacio Garcia-Valladares11, Theresa Lawrence-Ford12, Adrian Godoy10, Akgun Ince13 and Cindy Flower14, 1Rheumatology, Lousiana State University and LSU Medical Center, New Orleans, LA, 2Medicine-Section of Rheum, LSU Medical Center, New Orleans, LA, 3Rheumatology, Washington DC VAMC and Georgetown University and Howard University Hospital, Washington, DC, 4Pediatrics and Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, 5Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, 6New York University Hospital for Joint Diseases, New York, NY, 7Rheum/Immunology, Centre Rheum Immunol Arthritis, Fort Lauderdale, FL, 8Dept Medicine Div of Rheum, East Carolina University, Greenville, NC, 9John Dingell VAMC, Detroit, MI, 10Division of Rheumatology, Howard University, Washington, DC, 11Rheumatology, Guadalajara, Guadalajara, Mexico, 12North Georgia Rheumatology Group, PC, Lawrenceville, GA, 13Arthitis Consultants Inc, Saint Louis University, St. Louis, MO, 14Medicine, University of the West Indies, Bridgetown, Barbados

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: Ethnic studies, rheumatoid arthritis (RA) and tobacco use

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Session Information

Title: Rheumatoid Arthritis - Clinical Aspects II: Predictors of Disease Course in Rheumatoid Arthritis - Treatment Approaches

Session Type: Abstract Submissions (ACR)

Background/Purpose: Although the etiology of rheumatoid arthritis (RA) is unknown, there are reported interactions of genetic and environmental factors. Tobacco exposure is a well-documented risk factor, both in Caucasian and African American (AA) RA cohorts for disease susceptibility and severity. Yet there are no data addressing the association of tobacco use with RA-phenotypic expression, particularly within multi-ethnic cohort, specifically Hispanic patients. We examined the association of tobacco exposure and RA phenotype in a diverse ethnic RA cohort.

Methods: Patients enrolled in EMRAC, with baseline demographics data (age, gender, tobacco use), RA disease status (severity [RF, ACPA, nodules, erosions], activity [TJC, SJC, ESR, CRP, CDAI, DAS28, RAPID3], and extra-articular manifestations) were available for analysis. Smoking status was categorized as current, former, or never use. Comparisons of RA-features with smoking status between ethnic groups were analyzed using Cochran-Mantel-Haenzel test. Any association between tobacco exposure and clinical disease activity measures and outcomes were estimated using logistic regression adjusting for race (Caucasian vs. Non-Caucasian), age and disease duration.

Results: Of 861 EMRAC patients available for analysis, the mean age was 56.3 (sd 13.5) years, and disease duration 10.2 (sd 10.1) years. 405 (47%) were Caucasians, 287 (33%) AA and 169 (20%) Hispanics. Erosions were reported in 10%, predominantly in AA (25%). Only 20% reported tobacco use (ever), and exposure was not associated with disease activity [high CDAI score: non-smokers (49%) vs. former (53%) and current smokers (62%) (p=0.253); high DAS 28 score: non-smokers (61%) vs. former (62%) and current smokers (78%) (p=0.205); high RAPID3: non-smokers (74%) vs. former (75%) and current smokers (75%) (p=0.713)] or frequency of extra-articular disease in the cohort.

Smoking ever (former or current) was associated with erosive disease, adjusting for ethnic groups (p=0.002). Smoking ever had a 144% increase in odds of having erosions compared to never smoking (OR=2.44, p=0.003), and non-Caucasians had 638% increase in odds for erosions compared to Caucasians (OR=7.38, p<0.001) in a multiple logistic regression adjusting for disease duration, age and disease activity (Table).

Conclusion: In a diverse ethnic RA cohort, cigarette smoking and non-Caucasian ethnicity were independently associated with higher risk of erosive disease. While further studies are developed to better understand the relationship of tobacco exposure and RA, more aggressive anti-smoking efforts and counseling, as well as more aggresive RA therapy, appears warranted in ethnic minorities with the disease.

Table: Multiple Logistic Regression Model (Dependent Variable: Erosion)

Variables

OR (95% CI)

p

Smoking (Reference=Never)

2.44 (1.34-4.39)

0.003

Race (Reference=White)

7.38 (3.44-18.04)

<0.001

Disease duration (years)

1.05 (1.03-1.08)

<0.001

Age (years)

1.01 (1.00-1.04)

0.142

RAPID3

0.97 (0.93-1.01)

0.100


Disclosure:

R. Perez Alamino,
None;

L. R. Espinoza,
None;

G. S. Kerr,

Genentech and Biogen IDEC Inc., 2, Pfizer Inc, 2, Bristol Myers Squibb, 2,

2;

C. Swearingen,
None;

C. Luo,
None;

Y. Yazici,

BMS, Genentech, Celgene, 2, Abbvie, Pfizer, UCB Pharma, 5,

2;

Y. R. S. Sherrer,

UCB, lilly, GSK, Astrazeneca,

2,

AspraZeneca, GSK, Amgen, Pfizer,

8;

E. L. Treadwell,
None;

A. D. Mosley-Williams,
None;

S. Dowell,
None;

I. Garcia-Valladares,
None;

T. Lawrence-Ford,

Amgen, Pfizer, UCB, Abbvie, Takeda.GSK,

8;

A. Godoy,
None;

A. Ince,
None;

C. Flower,
None.

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