Smokers with spondyloarthritis had worse disease vs nonsmokers

Jones GT, et al. Arthritis Care Res. 2017;doi:10.1002/acr.23157.
September 27, 2017

Among patients with spondyloarthritis, smokers experience more severe disease vs. nonsmokers, according to recent findings.

Researchers acquired clinical data on 946 patients with ankylosing spondylitis (73.5% were men; mean age, 52 years) who participated in the Scotland Registry for Ankylosing Spondylitis. Researchers extracted clinical data from medical records, including time since diagnosis, disease activity as measured by the bath ankylosing spondylitis disease activity index (BASDAI), function as measured by the bath ankylosing spondylitis functional index (BASFI) and metrology as assessed by the bath ankylosing spondylitis metrology (BASM).

Patient characteristics were evaluated using self-administered postal questionnaires. These questionnaires asked participants to categorize themselves as never smokers, ex-smokers or current smokers. The ankylosing spondylitis quality of life (ASQoL) questionnaire, the EuroQol, and the SF-36 physical and mental component summary scores were collected. Researchers used linear and logistic regression, adjusted for age, gender, socioeconomic deprivation, education level and alcohol use, to determine the effect of smoking and of smoking cessation, on various disease-specific and QoL outcomes.

Researchers found 22% of patients reported being current smokers, while 37.7% reported being ex-smokers and 40.6% identified as never-smokers.

There was significantly poorer disease activity, function and metrology in ever-smokers vs. never-smokers, the equivalent of between 0.8 and 1.2 units on the BASDAI, BASFI and BASMI. Adjustment for gender, socioeconomic deprivation, education and alcohol status reduced these effects, but the significantly higher scores among ever-smokers persisted.

Ever-smokers had a 1.5-point increase in ASQoL score, which signified poorer disease-specific quality of life and had significant reductions in all generic quality of life parameters, physical component score and mental component score.
Compared with current smokers, formers smokers cited less disease activity and significantly better QoL. Ex-smokers also were 2.4-times more likely to have a history of uveitis.

“We have confirmed that, even after adjustment for a number of important confounding factors, patients with SpA who have ever smoked experience poorer disease outcomes than never smokers,” the researchers wrote. “Furthermore, we present new evidence to suggest that smoking cessation is associated with substantially improved disease activity, disease-related function, and quality of life scores.” –by Jennifer Byrne

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