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.


Cigarette Smoking and Cutaneous Damage in Patients with Systemic Lupus Erythematosus.

Bourre-Tessier5,  Josiane, Peschken13,  Christine A., Joseph5,  Lawrence, Belisle5,  Patrick, Clarke7,  Ann E., Bernatsky3,  Sasha R., Hudson6,  Marie

Ch Maisonneuve-Rosemont, Montreal, QC, Canada
TOH Riverside Campus, Ottawa, ON, Canada
Toronto Western Hospital, Toronto, ON, Canada
Toronto Western Hospital, Toronto, ON, Canada
Univ of Manitoba, Winnipeg, MB, Canada
University of Manitoba, Winnipeg, MB, Canada
Chinook Regional Hospital
McGill UHC/RVH, Montreal, QC, Canada
McGill Univ Health Center, Montreal, QC, Canada
McGill University
McGill University and Jewish General Hospital
Montreal General Hospital, Montreal, QC, Canada
St Joseph Health Care London, London, ON, Canada
The Toronto Western Hospital, Toronto, ON, Canada

Background:

In patients with systemic lupus erythematosus (SLE), cutaneous damage is common and can produce considerable morbidity. Moreover, since smoking may decrease the effectiveness of antimalarial agents, tobacco use may be associated with increased skin manifestations in SLE patients. We examined the association between cigarette smoking and cutaneous involvement in a multicenter Canadian SLE cohort.

Methods:

Adults with SLE were enrolled in a multicenter cohort. Various cutaneous elements, as recorded at last visit by the SLICC/ACR Damage Index (SDI; alopecia, extensive scarring and skin ulceration) and the ACR criteria (discoid rash, malar rash and photosensitivity) were used as primary outcomes. Cross-sectional analysis with multivariate logistic regression models were used to estimate the association between cigarette smoking (defined as smoking regularly 3 or more months in the lifetime) and cutaneous involvement. Other potentially associated factors included age, sex, lupus duration, medication including antimalarials, and laboratory data.

Results:

In our cohort of 1724 adults, most (83.3%) were female, mean age (SD) was 40.7 years (17.9), mean disease duration was 12.4 years (10.1) and 36.1% had smoked regularly in their lifetime. Cutaneous involvement included malar rash (59.9%), photosensitivity (50.7%), alopecia (11.0%), extensive scarring (3.5%), discoid rash (3.4%) and skin ulceration (0.2%). In multivariate analysis, smoking was associated with discoid rash (OR 1.96; 95%CI 1.41–2.71) and photosensitivity (1.52; 1.17–2.00). We did not find an association between smoking and alopecia, extensive scarring, skin ulceration or malar rash. An association between antimalarials and skin manifestations was expected since antimalarials are regularly used to treat cutaneous involvement in SLE. Indeed, the use of hydroxychloroquine was associated with discoid rash (2.23; 1.10–4.53) and malar rash (2.0; 1.02–3.93) in multivariate analysis.

Conclusion:

Cigarette smoking is associated with discoid rash and photosensitivity in this large cohort of SLE patients. Our results emphasize the need to counsel patients on smoking cessation.

To cite this abstract, please use the following information:
Bourre-Tessier, Josiane, Peschken, Christine A., Joseph, Lawrence, Belisle, Patrick, Clarke, Ann E., Bernatsky, Sasha R., et al; Cigarette Smoking and Cutaneous Damage in Patients with Systemic Lupus Erythematosus. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1850
DOI: 10.1002/art.29615

Abstract Supplement

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