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SLE patients who smoke were more likely to have rash
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Patients with systemic lupus erythematosus who smoke were more likely to have an active rash, while patients who ever smoked were likely to have ACR criteria for cutaneous involvement, according to recent study results.
Christian A. Pineau, MD, assistant professor of medicine, McGill University, Montreal, and colleagues evaluated data from a multicenter Canadian cohort of 1,346 patients with systemic lupus erythematosus (SLE; mean age, 47.1 years; 91% women) with a mean disease duration of 13.2 years. Treatment included antimalarials (69.9%) and immunosuppressant drugs (34.8%). Of the patients, 41.1% reported ever smoking (14%, current smokers; 27.1%, former smokers).
Christian A. Pineau
SLE Disease Activity Index 2000, the Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index (SDI) and ACR criteria for malar rash, discoid rash, photosensitivity and mucosal involvement were used to measure mucocutaneous involvement at most recent visit. Independent associations between mucocutaneous involvement and cigarette smoking, age, sex, lupus duration, medications and laboratory data were measured through multivariate logistic regression models.
Active cutaneous manifestations were present in 28.4% of patients, with cutaneous damage from SDI occurring in 15.4% of patients. ACR criteria for malar rash were noted in 59.5% of patients, discoid rash in 16.9% and photosensitivity in 55.7%. Multivariate analysis showed that current smoking was associated with an active SLE rash (OR=1.63; 95% CI, 1.07-2.48). Patients who ever smoked had an association with the presence of cutaneous ACR criteria (OR=1.50; 95% CI, 1.22-1.85), with specific items of discoid rash (OR=2.36; 95% CI, 1.69-3.29) and photosensitivity (OR=1.47; 95% CI, 1.11-1.95).
There was no association between previous smoking and active cutaneous manifestations. Cutaneous damage and mucosal ulcers were not associated with smoking. There also was no interaction between smoking and antimalarials.
“Tobacco smoking is a serious and preventable health hazard that can cause and exacerbate a number of diseases, including cutaneous disease in SLE patients,” the researchers concluded. “The prevalence of active smoking, 14% in our cohort, remains too high and the need to counsel patients on smoking cessation should be emphasized.”
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