Original Article

Smoking is associated with cutaneous manifestations in systemic lupus erythematosus

  1. Josiane Bourré-Tessier MD, MSc,
  2. Christine A Peschken MD, MSc,
  3. Sasha Bernatsky MD, PhD,
  4. Lawrence Joseph PhD,
  5. Ann E Clarke MD, MSc,
  6. Paul R Fortin MD, MPH,
  7. Carol Hitchon MD, MSc,
  8. Shikha Mittoo MD, MHS,
  9. C Douglas Smith MD,
  10. Michel Zummer MD,
  11. Janet Pope MD, MPH,
  12. Lori Tucker MD,
  13. Marie Hudson MD, MPH,
  14. Hector Arbillaga MD,
  15. John Esdaile MD, MPH,
  16. Earl Silverman MD,
  17. Gaelle Chédeville MD,
  18. Adam M Huber MD, MSc,
  19. Patrick Belisle MSc,
  20. CaNIOS 1000 Canadian Faces of Lupus investigators,
  21. Christian A Pineau MD†,*

DOI: 10.1002/acr.21966

Additional Information

Author Information

  1. Canadian Network for Improved Outcomes in Systemic Lupus Erythematosus (CaNIOS)

  1. †

    Telephone: 514-934-8037; Fax number: 514-934-8239

*The Montreal General Hospital, 1650 Cedar Avenue, A6.163, Montreal, Quebec H3G 1A4

  1. CaNIOS 1000 Faces Investigators are as follows: Murray B Urowitz, Dafna D Gladman, Carolina Landolt-Marticorena: Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada; Sai Yan Yuen: Hopital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada; Deborah M Levy: Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada, Suzanne Ramsey: IWK Grace Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada, Jean-Luc Senécal, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada.

  2. †

    Telephone: 514-934-8037; Fax number: 514-934-8239

  3. CaNIOS 1000 Faces Investigators are as follows: Murray B Urowitz, Dafna D Gladman, Carolina Landolt-Marticorena: Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada; Sai Yan Yuen: Hopital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada; Deborah M Levy: Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada, Suzanne Ramsey: IWK Grace Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada, Jean-Luc Senécal, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada.

Publication History

  1. Accepted manuscript online: 11 FEB 2013 10:07AM EST
  2. Manuscript Accepted: 16 JAN 2013
  3. Manuscript Revised: 22 DEC 2012
  4. Manuscript Received: 2 MAY 2012

Funded by

  • The 1000 Faces of Lupus was funded
  • Arthritis Society and a grant from The Lupus Society of Manitoba

SEARCH

SEARCH BY CITATION

ARTICLE TOOLS

Get PDF (497K)

Abstract

Objective:

To examine the association between smoking and cutaneous involvement in SLE.

Methods:

We analyzed data from a multicenter Canadian SLE cohort. Muco-cutaneous involvement was recorded at most recent visit, using the SLEDAI-2K (rash, alopecia, oral ulcers), the SLICC/ACR Damage Index (SDI; alopecia, extensive scarring and skin ulceration) and the ACR criteria (malar rash, discoïd rash, photosensitivity, mucosal involvement). Multivariate logistic regression models were used to estimate independent association between muco-cutaneous involvement and cigarette smoking, age, sex, lupus duration, medications, and laboratory data.

Results:

In our cohort of 1346 patients, 91.0% were female, with mean age 47.1 years (standard deviation, SD 14.3) and mean disease duration of 13.2 years (SD 10.0). A total of 41.2% reported ever smoking, 14.0% were current smokers and 27.1% were past smokers. Active cutaneous manifestations occurred in 28.4%; cutaneous damage occurred in 15.4%. Regarding ACR criteria, malar rash was noted in 59.5%, discoid rash in 16.9%, and photosensitivity in 55.7%. In multivariate analysis, current smoking was associated with active SLE rash (OR 1.63; 95% CI 1.07-2.48). Having ever smoked was associated with the ACR criteria discoid rash (2.36; 1.69-3.29) and photosensitivity (1.47; 1.11-1.95), and with the total cutaneous ACR score (1.50; 1.22-1.85). We did not detect associations between previous smoking and active cutaneous manifestations. No association was found between smoking and cutaneous damage or mucosal ulcers. No interaction was seen between smoking and antimalarials.

Conclusion:

Current smoking is associated with active SLE rash, and ever smoking with cutaneous ACR criteria. This provides additional motivation for smoking cessation in SLE. © 2013 by the American College of Rheumatology

Get PDF (497K)