Associations Between Smoking and Primary Sjögren Syndrome Classification Using the Sjögren's International Collaborative Clinical Alliance Cohort

Abstract

Objective. The objective of this study was to examine the association of smoking with Primary Sjögren syndrome (pSS) classification and pSS diagnostic test results. We hypothesized that past and current smokers would have lower odds of being classified as having Sjögren syndrome (SS) and lower odds of having abnormal individual SS diagnostic test results compared with nonsmokers.Methods. Participants with suspected or established pSS were enrolled into the Sjögren's International Collaborative Clinical Alliance (SICCA) registry and had oral, ocular, and rheumatologic examinations performed; blood and saliva samples collected; and labial salivary gland biopsy examinations performed; they also completed questionnaires at baseline. Logistic regression was used to determine whether smoking status was associated with pSS classification and individual pSS diagnostic test results.Results. A total of 3514 participants were enrolled in SICCA. A total of 1541 (52.9%) met classification criteria for pSS. Compared with never smokers, current smokers had reduced odds of being classified as having pSS, reduced odds of having a focus score ≥ 1 and serologic positivity for anti-SSA/anti-SSB antibodies, and lower odds of having abnormal signs or test results of dry eye disease. Compared with never smokers, past smokers did not have a statistically significant reduction in odds of being classified as having pSS and of having abnormal individual pSS diagnostic test results.Conclusion. Compared with never smokers, current smokers in the SICCA cohort had lower odds of being classified as having pSS, lower odds of exhibiting abnormal signs and test results for dry eye disease, and lower odds of having a labial salivary gland biopsy supportive of pSS classification. Such negative associations, however, do not suggest that current smoking is of any benefit with respect to pSS.

Sex differences in comorbidities associated with Sjögren's disease

“…Patients with Sjögren's disease have also been reported to have more hypertension and type II diabetes which increase the risk for cardiovascular disease (32), but to smoke less because of symptoms of dry mouth (30). Multiple studies have demonstrated an inverse correlation of smoking and Sjögren's disease or for smoking and focal lymphocytic sialadenitis (33)(34)(35)(36)(37)(38)(39)(40), but differences between sex have not been reported. In this study a higher percentage of men with Sjögren's disease were smokers than women (49% men vs. 32% women), although the number of patients with data on smoking is relatively low (Table 2).…”

Genetics and epigenetics of primary Sjögren syndrome: implications for future therapies

“…Regarding other environmental factors implicated in autoimmunity, smoking is an established risk factor for seropositive RA 120 . By contrast, smoking is not thought to increase the risk of pSS development [121][122][123][124] . Instead, in the years preceding a diagnosis, individuals who later develop pSS are more prone to stop smoking than the general population 121 , and no discernible interactions have been detected between smoking and risk-related HLA alleles 121 .…”