Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement
The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.
Is Cigarette Smoking An Independent Correlate of Health Related Quality of Life in Patients with Systemic Lupus Erythematosus?
Jolly, Meenakshi, Patel, Ravikumar, Aggarwal, Rohit, Sequeira, Winston, Block, Joel A.
To determine if cigarette smoking is an independent determinant of health related quality of life (HRQOL), irrespective of its association with disease activity and damage in patients with systemic lupus erythematosus (SLE).
The data were extracted from an ongoing study on HRQOL in SLE. Consecutive consenting adult SLE patients seen in the rheumatology clinic at an academic hospital were enrolled from September 2006 to April 2008 and detailed clinical and demographic variables were collected from 216 SLE patients. The HRQOL was assessed by MOS-SF-36 and EuroQol-5D (EQ-5D). The SF-36 has 8 domains: Physical Functioning, Role Physical, Bodily Pain, General Health, Vitality, Social Functioning, Mental Health and Role Emotional. It also provides two summary scores: Physical Component Score (PCS) and Mental Component Score (MCS). The EQ-5D is composed of the following domains: Mobility, Self care, Usual Activities, Pain/Discomfort and Anxiety/Depression. In addition, it includes a Visual Analog Scale (VAS) and an EQ-5D Summary Index. Smoking was defined as present if the subject reported smoking at the time of the study. Chi-Square test and Mann Whitney test were used to make comparisons between the cases 'smoker' and controls 'non-smoker'. Hierarchical linear regression analysis was performed using HRQOL as the dependent variable. In first model, the predictor variable was disease activity (SLEDAI). In second model, disease damage (SLICC) was added to first model. In final model, we added smoking status to second model. R square change for each model was noted. P < 0.05 was considered significant on one tailed test.
The mean (±SD) age of participants was 42 ± 13 years and 93 % were females. The ethnic composition was: African American 60%, Caucasian 20%, Hispanic 14% and Asian 6%. Fifteen percent of subjects reported "currently smoking" status at the time of the study. Smokers had worse HRQOL than non smokers: specifically, differences were noted for physical function, bodily pain and vitality domains of SF-36 as well as on PCS (mean ± S.D, median): physical functioning (45.6 ± 28.3, 50 vs. 56 ± 28.8, 55; p 0.047), bodily pain (38.2 ± 18.5, 41 vs. 54.6 ± 27.6, 51; p 0.001), vitality (38.2 ± 21.4, 45 vs. 49.1 ± 21.6, 50; p 0.012) and PCS (31.1 ± 9.4, 31 vs. 36.1 ± 11.2, 36.6; p 0.017). On EQ5D, smokers had worse functioning on anxiety/depression and visual analog scale: anxiety/depression for extreme problems (10 % vs. 4.5 %, p 0.049), anxiety/depression for some problems (56.6 % vs. 42.3 %, p 0.049) and visual analog scale (61.5 ± 22.4, 60 vs. 68.9 ±20, 70; p 0.048).
On hierarchical regression analysis, disease activity alone explained 3% of the variance in PCS (R square 0.027); disease activity and damage explained similar variance in PCS (R square change 0.028) and addition of smoking variable, increased the variance explained in PCS to 5% (R square change 0.049).
Cigarette smoking is independently associated with worse health outcomes in SLE, although it explains a relatively minor component of variance. Patients with SLE should be screened aggressively and counseled for their smoking history.
To cite this abstract, please use the following information:
Jolly, Meenakshi, Patel, Ravikumar, Aggarwal, Rohit, Sequeira, Winston, Block, Joel A.; Is Cigarette Smoking An Independent Correlate of Health Related Quality of Life in Patients with Systemic Lupus Erythematosus? [abstract]. Arthritis Rheum 2009;60 Suppl 10 :294