The effect of smoking on clinical and radiographic variables, and acute phase reactants in patients with ankylosing spondylitis

Abstract

To investigate the association between smoking and clinical, inflammatory and radiographic parameters in patients with ankylosing spondylitis (AS). One hundred and six tumour necrosis factor inhibitor naïve patients with AS were included in the study. The erythrocyte sedimentation rate, C-reactive protein, Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI) and modified Stroke AS Spine Score (mSASSS) were assessed cross-sectionally for each patient. Smoking history was obtained, and smoking pack years were calculated. Current smokers had significantly higher BASDAI (p < 0.001) and a trend for higher BASFI (p = 0.059). Ever smokers had significantly higher BASFI (p = 0.035) and a trend for higher mSASSS (p = 0.063) compared to never smokers. Pack years (smoking intensity) were positively correlated with duration of inflammatory back pain (r = 0.628, p < 0.001), BASFI (r = 0.443, p < 0.001) and mSASSS (r = 0.683, p < 0.001). Multivariate regression analyses showed that current smoking was independently associated with a higher BASDAI score [regression coefficient (B) = 14.75, p < 0.001] and increasing pack years were independently associated with higher mSASSS (B = 0.26, p = 0.005). In patients with AS, current smoking was strongly and independently associated with higher disease activity, and cumulative smoking exposure with more radiographic spinal damage. In AS smokers, smoking cessation should be strongly recommended.

Increasing smoking intensity is associated with increased disease activity in axial spondyloarthritis

“…This could not be explained by age or gender (factors associated with radiographic progression); current smokers were younger with shorter disease and symptom duration and did not have more males than other groups. Other studies have reported greater radiographic progression in AS smokers [9, 10, 12]. …”

“…The three remaining studies reported no associations between markers of disease severity and pack-years [11, 12, 16]. There are several possible explanations for the inconsistent results.…”

“…Firstly, it is important to consider confounders when studying smoking and disease activity. Some studies used simple correlation [8, 16] and others used variable approaches when selecting covariates [12, 13]. Secondly, most studies recruited smaller cohorts with fewer (35–84 patients) entered into pack-year analysis [8, 11–13].…”

Axial Spondyloarthritis and Cigarette Smoking

“…The more the patients smoke the more they kept the disease active because the tobacco acts by causing the inflammation from where staying smoker keeps the inflammation but it was not possible to say whether it depended on the intensity of the smoking It was not possible to collect data on the basis of number of packets per day or per week to have the number of packets accumulate over the year.This seems to be the object of several studies in the literature that have become more Based on the influence of smoking on the activity of spondyloarthritis, in particular the effect of smoking on the activity of spondyloarthritis [17, 18, 23-27]. They demonstrated that smoking AS patients had significantly higher activity by the BASDAI scores [3, 14-24].…”

“…In addition, smoking appears among the factors associated with an increased risk of advanced disease, higher activity and early onset of inflammatory back pain in young patients [17, 18]. …”