The objective of the study is to study the positivity of Coombs test or direct antiglobulin test (DAT) in systemic lupus erythematosus (SLE) patients and its relationship with disease's clinical and serological profile. Retrospective study of 373 SLE patients seen at single Rheumatology Unit. Epidemiological data (age, gender, age at disease onset, auto declared ethnic background and tobacco use), clinical (malar rash, photosensitivity, oral ulcers, discoid lesions, serositis, glomerulonephritis, convulsions, psychosis, hemolytic anemia, leukopenia, lymphocytopenia and arthritis), and serological profile (anti ds DNA, anti Ro/SS-A; anti La/SS-B, Anti RNP, Anti Sm, aCl (anticardiolipin) IgG, aCl Ig M, LA or lupus anticoagulant, rheumatoid factor and direct Coombs) were collected. Patients with a positive DAT were compared with the negatives. DAT was positive in 12.8% of patients and 54.3% of them had hemolytic anemia. In univariate analysis, a positive DAT was associated with hemolytic anemia (p < 0.0001), secondary antiphospholipid antibody syndrome (p = 0.02), anticardiolipin IgG (p < 0.0001), lupus anticoagulant (p = 0.05), positive VDRL (p = 0.004), anti-RNP (p < 0.0001), anti-Sm (p = 0.002), and anti-La (p = 0.02). Logistic regression revealed that hemolytic anemia, anti-RNP and anti-LA were independently associated with positive DAT. DAT was positive in 12.8% of SLE studied sample and 54.3% of them had hemolytic anemia. This test was independently associated with hemolytic anemia, anti-RNP and anti-La antibodies.

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BACKGROUNDSystemic lupus erythematosus (SLE) is a multisystemic, chronic inflammatory disease of unknown cause and autoimmune nature. Tobacco has effects on SLE disease activity, since it has several chemical factors that affect cell growth. Cigarette chemicals are metabolized, generating free radicals that interact with DNA and cause oxidative damage to nuclear constituents. It also modifies the response to drug treatment: antimalarial and belimumab are medications that suffers influence of tobacco. The aim of this study was to compare the cumulative disease damage in SLE patients with and without tobacco exposure. METHODSRetrospective study of 100 SLE patients: 50 smokers vs. 50 nonsmokers from a single rheumatology center. Collected information included epidemiological, clinical and laboratory data to calculate cumulative damage through the Systemic Lupus International Collaborating Clinics /American College of Rheumatology (SLICC/ACR) damage index. RESULTSSmokers and nonsmokers patients were paired for gender, age and disease duration. No differences between the two groups were observed in the total result of SLICC/ACR damage index. However, when the different domains were studied, smokers had more ocular and cardiovascular damage than nonsmokers (both with p-0.02). CONCLUSIONSystemic lupus erythematosus patients that smoke have more cumulative damage including the cardiovascular and ocular areas.

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