Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.

Does Smoking Influence Disease Manifestations and Disease Severity in Systemic Lupus Erythematosus?

Ghanim2,  Nayef Al, Ghanem2,  Aqeel, Nahar1,  Ebrahim, Esdaile2,  John M., Lacaille2,  Diane

Mubarak Al Kabeer Hospital, Vancouver, BC, Canada
University of British Columbia, Vancouver, BC, Canada


Several studies have established that smoking is a risk factor for Systemic Lupus Erythematous (SLE). However, few studies have evaluated whether smoking influences disease manifestations or disease activity and severity.

The objective of our study was to evaluate whether smoking is associated with differences in pattern of organ involvement and with greater disease severity, as measured by the SLICC.


A retrospective medical chart review was conducted between 2002 and 2005 of all SLE patients seen since 1990 from eight rheumatology practices. All patients included met the 1982 ACR criteria for SLE. Data were extracted on: demographics, SLE duration, SLE treatment, SLICC, and organ involvement using predefined criteria derived from the SLAM, and current smoking status at baseline (ie time of first rheumatologist visit). Smokers and non-smokers were compared using Chi-square for categorical variables and Student t-test for continuous variables. To take into account the multiple comparisons tested, we considered p < 0.01 as statistically significant. SLICC score, because of its skewed distribution, was analyzed as a binary variable with a cut off of 2 (i.e. values of 0 or 1 vs. values of 2 or greater). Multivariable binary logistic regression analysis was performed with SLICC score as the dependent variable, controlling for SLE duration, age, gender, and ethnicity.


Our sample included 306 patients, 52 were smokers and 254 non-smokers (92% women, mean (SD) age 43.3 (12.9) years, disease duration 12.2 (8.8) years). No significant differences were observed in the pattern of organ involvement between smokers and non-smokers (Table 1). A trend was observed with smokers having increased frequency of antiphospholipid syndrome (APLS) compared to non-smokers (31.4% vs 16.9%, respectively. p= 0.03). However, it did not reach statistical significance at the preselected level of p < 0.01. No difference was observed in the medications received for SLE, such as glucocorticosteroids or immunosuppressant medications (data not shown). After adjusting for age, gender, disease duration and ethnicity, the likelihood of severe disease, as measured by SLICC >= 2, was not increased in smokers compared to non-smokers (OR: 1.18, 95% CI: 0.56–2.46).


In our sample of SLE patients, there was no association between smoking and the pattern of organ involvement or disease severity measured by SLICC.

Organ involvementNon - smokers (n=254)Smokers (n=52)p value
Mucocutaneous216 (85%)47 (92%)0.26
MSK228 (90%)46 (90%)1
Renal89 (36%)12 (25%)0.13
CNS140 (55%)30 (59%)0.64
Hematological220 (87%)38 (75%)0.03
APLS43 (17%)16 (31%)0.03
Pulmonary85 (34%)23 (45%)0.14
Cardiac52 (21%)8 (16%)0.56
GI8 (3%)1 (2%)1
Abbreviations: MSK: Musculoskeletal; CNS: Central Nervous System; APLS: Antiphospholipid syndrome; GI: Gastrointestinal

To cite this abstract, please use the following information:
Ghanim, Nayef Al, Ghanem, Aqeel, Nahar, Ebrahim, Esdaile, John M., Lacaille, Diane; Does Smoking Influence Disease Manifestations and Disease Severity in Systemic Lupus Erythematosus? [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1152
DOI: 10.1002/art.28918

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