title: Smoking did not modify the effects of anti-TNF treatment on health-related quality of life among Australian ankylosing spondylitis patients.
abstract: OBJECTIVE
  The aim of this study was to examine the impact of smoking on health-related quality of life (HRQoL) among AS patients who were taking biologic DMARDS.
  
  
  METHODS
  This is a longitudinal cohort study of AS patients with anti-TNF treatment in the Australian Rheumatology Association Database (2003-11). They were assessed using the 36-item Short Form Health Survey (SF-36), Assessment of Quality of Life (AQoL) and HAQ for spondylitis (HAQ-S) on a biannual basis. Linear mixed models were used to assess the impact of smoking on HRQoL outcomes over the first 2 years of treatment.
  
  
  RESULTS
  Four hundred and twenty-two patients [73% male, mean age 44.9 years (s.d. 12.7) provided 1189 assessments for the study. Current smokers (n = 79) were slightly younger, more likely to be male, less likely to use or to have previously used prednisolone and had a slightly shorter disease duration than past smokers (n = 138) or non-smokers (n = 205). After adjusting for smoking, gender, age, education, employment, co-morbidities and medication use, including DMARDs, anti-inflammatories and analgesics, all the HRQoL measures improved significantly over the study period and the improvements were not modified by smoking status (all P-values >0.36). Current smokers tended to have a poorer HRQoL on the SF-36 physical score [-1.93 (95% CI -3.94, 0.09), P = 0.06] and the HAQ-S score [0.10 (95% CI -0.01, 0.20), P = 0.07] compared with non-smokers.
  
  
  CONCLUSIONS
  Among AS patients, active smoking did not diminish or modify the improvements in HRQoL from anti-TNF treatment, even though current smokers compared with non-smokers tended to have poorer scores in some HRQoL measures.
authors.affiliation: Division of Rheumatology, University of British Columbia, Vancouver, BC, Canada, Institute of Bone and Joint Research, University of Sydney, Sydney, NSW, CCRE Therapeutics, Monash University, Monash Department of Clinical Epidemiology, Cabrini Hospital, Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC and Department of Rheumatology, St George Hospital, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Alison S R
authors.initials: AS
authors.lastname: Kydd
authors.affiliation: Division of Rheumatology, University of British Columbia, Vancouver, BC, Canada, Institute of Bone and Joint Research, University of Sydney, Sydney, NSW, CCRE Therapeutics, Monash University, Monash Department of Clinical Epidemiology, Cabrini Hospital, Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC and Department of Rheumatology, St George Hospital, University of New South Wales, Sydney, NSW, Australia. jschen@med.usyd.edu.au.
authors.forename: Jian Sheng
authors.initials: JS
authors.lastname: Chen
authors.affiliation: Division of Rheumatology, University of British Columbia, Vancouver, BC, Canada, Institute of Bone and Joint Research, University of Sydney, Sydney, NSW, CCRE Therapeutics, Monash University, Monash Department of Clinical Epidemiology, Cabrini Hospital, Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC and Department of Rheumatology, St George Hospital, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Joanna
authors.initials: J
authors.lastname: Makovey
authors.affiliation: Division of Rheumatology, University of British Columbia, Vancouver, BC, Canada, Institute of Bone and Joint Research, University of Sydney, Sydney, NSW, CCRE Therapeutics, Monash University, Monash Department of Clinical Epidemiology, Cabrini Hospital, Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC and Department of Rheumatology, St George Hospital, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Vibhasha
authors.initials: V
authors.lastname: Chand
authors.affiliation: Division of Rheumatology, University of British Columbia, Vancouver, BC, Canada, Institute of Bone and Joint Research, University of Sydney, Sydney, NSW, CCRE Therapeutics, Monash University, Monash Department of Clinical Epidemiology, Cabrini Hospital, Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC and Department of Rheumatology, St George Hospital, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Lyndall
authors.initials: L
authors.lastname: Henderson
authors.affiliation: Division of Rheumatology, University of British Columbia, Vancouver, BC, Canada, Institute of Bone and Joint Research, University of Sydney, Sydney, NSW, CCRE Therapeutics, Monash University, Monash Department of Clinical Epidemiology, Cabrini Hospital, Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC and Department of Rheumatology, St George Hospital, University of New South Wales, Sydney, NSW, Australia. Division of Rheumatology, University of British Columbia, Vancouver, BC, Canada, Institute of Bone and Joint Research, University of Sydney, Sydney, NSW, CCRE Therapeutics, Monash University, Monash Department of Clinical Epidemiology, Cabrini Hospital, Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC and Department of Rheumatology, St George Hospital, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Rachelle
authors.initials: R
authors.lastname: Buchbinder
authors.affiliation: Division of Rheumatology, University of British Columbia, Vancouver, BC, Canada, Institute of Bone and Joint Research, University of Sydney, Sydney, NSW, CCRE Therapeutics, Monash University, Monash Department of Clinical Epidemiology, Cabrini Hospital, Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC and Department of Rheumatology, St George Hospital, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Marissa
authors.initials: M
authors.lastname: Lassere
authors.affiliation: Division of Rheumatology, University of British Columbia, Vancouver, BC, Canada, Institute of Bone and Joint Research, University of Sydney, Sydney, NSW, CCRE Therapeutics, Monash University, Monash Department of Clinical Epidemiology, Cabrini Hospital, Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC and Department of Rheumatology, St George Hospital, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Lyn M
authors.initials: LM
authors.lastname: March
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001685:Biological Factors / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011788:Quality of Life; D012907:Smoking / Q000009:adverse effects*; D013167:Spondylitis, Ankylosing / Q000188:drug therapy*; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D018501:Antirheumatic Agents; D001685:Biological Factors; D014409:Tumor Necrosis Factor-alpha
keywords: SF-36; ankylosing spondylitis; anti-TNF drugs; quality of life; smoking