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Smoking raises risk of active skin manifestations in SLE



Major Finding: Current smokers with systemic lupus erythematosus were 63% more likely than past or never smokers to have an active SLE rash.

Data Source: A cohort study of 1,346 SLE patients aged 16 years and older, of whom 14% were current smokers and 27% were past smokers.

Disclosures: The 1000 Faces of Lupus Cohort was funded by the Arthritis Society and the Lupus Society of Manitoba. No financial conflicts of interest were reported.

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Smoking significantly raises the risk that patients with systemic lupus erythematosus will develop active cutaneous manifestations of the disease, based on data from a multicenter cohort study of 1,346 patients.

Overall, current smokers were 63% more likely than former or never smokers to have an active SLE rash after controlling for multiple variables. In addition, patients who had ever smoked were more than twice as likely to meet the American College of Rheumatology criteria for discoid rash (odds ratio, 2.36) and photosensitivity (odds ratio, 1.47).


Current smokers were 63% more likely than former or never smokers to have an active SLE rash.


The study is the largest to date examining the effect of smoking on cutaneous outcomes in systemic lupus erythematosus (SLE), said Dr. Josiane Bourré-Tessier of the University of Montreal and her associates.

The researchers examined a possible association between smoking status and skin activity using data from the 1000 Faces of Lupus Cohort, a cohort of SLE patients who presented for care at 14 participating specialty clinics across Canada. The study population included 1,346 participants aged 16 years and older who enrolled between 2005 and 2009 (Arthritis Care Res. 2013 Feb. 11 [doi:10.1002/acr.21966]).

The patients were assessed using the SLE Disease Activity Index 2000 (SLEDAI-2K), which focuses on rash and alopecia; the Systemic Lupus International Collaborating Clinics/ACR Damage Index (SDI), which focuses on alopecia, extensive scarring, and skin ulceration; and the American College of Rheumatology (ACR) revised criteria for SLE, which focus on discoid rash, malar rash, and photosensitivity.

More than 90% of the study subjects were women, and 63% were white. The mean age was 47 years; mean disease duration was 13 years. Approximately 14% of the patients were current smokers and 27% were past smokers.

Most patients (70%) were taking antimalarials at the time of the study – 64% taking hydroxychloroquine and 6% taking chloroquine. Another 35% were taking immunosuppressants.

According to the SLEDAI-2K, 28% of patients had some mucocutaneous disease activity: 15% had rash, 13% had alopecia, 8% had mucosal ulcers, and 8% had at least two of these symptoms. According to the SDI, 12% had alopecia, including 4% with extensive scarring and 0.2% with skin ulceration. According to ACR criteria, 60% of patients had ever experienced malar rash; 17% had experienced discoid rash; 56%, photosensitivity; and 56%, ulcerations.

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