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Title: Tobacco smoking is an independent factor associated with retinal damage in systemic lupus erythematosus: a cross-sectional and retrospective study
Authors: Rúa-Figueroa, Iñigo
Erausquin, Celia
Rua-Figueroa, Celia
González-Martín, Jesús
Naranjo Hernández, Antonio 
Ojeda, Soledad
Francisco, Félix
Quevedo, Juan C.
Cáceres, Laura
López, Ruben
Greco, Martin
Altabás-González, Irene
Pérez, Yanira
Rubiño, Francisco
Rodríguez-Lozano, Carlos
UNESCO Clasification: 32 Ciencias médicas
Keywords: Lupus
Issue Date: 2019
Journal: Rheumatology International 
Abstract: To analyze the influence of tobacco smoking on systemic lupus erythematosus (SLE) clinical features and damage. Cross-sectional and retrospective, case–control study comparing SLE patients with and without tobacco exposure. Cumulative clinical data and comorbidities were collected, and severity (Katz index) and damage (SLICC/ACR damage index) (SDI) indices were calculated. Pack-years (PY) was used to estimate lifetime tobacco exposure. A logistic regression was carried out to explore the impact of tobacco use on retinal damage. 216 patients were included. The mean age was 49 years (± 12.7), 93% were females, and median disease duration was 17 years [interquartile range (IQR):9–25]. Fifty-three percent of patients were smokers at some point. The median PY was 13 (IQR: 6–20.5). Only 54.8% of active smokers recalled having been informed of the negative effects of smoking, versus 83.3% of never smokers (< 0.001). In a bivariant analysis, an association between tobacco use at any time and discoid lupus [OR: 3.5(95%CI 1.5–8.9); p = 0.002] photosensitivity [OR: 2.06(95%CI 1.16–3.7); p = 0.01] and peripheral arteriopathy (p = 0.007) was found. Considering SDI item by item, a significant association with retinal damage, adjusted for age [OR: 1.03(95%CI 1–1.07); p = 0.04], was found. Using PYs, an association was found with discoid lupus (p = 0.01), photosensitivity (p = 0.03) and peripheral arteriopathy (p = 0.01), global SDI > 0 (p = 0.002) and retinal damage (p = 0.02). In a multivariate analysis exploring factors associated with retinal damage, any previous smoking history and SDI remained associated with retinal damage. Tobacco smoking is associated with cutaneous manifestations and damage and is an independent predictor of retinal damage in SLE patients.
ISSN: 0172-8172
DOI: 10.1007/s00296-019-04473-8
Source: Rheumatology International [ISSN 0172-8172], v. 40, p. 367–374
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