title: Smoking and Its Association With Morbidity in Systemic Lupus Erythematosus Evaluated by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index: Preliminary Data and Systematic Review.
abstract: OBJECTIVE
  Due to the increased availability of effective treatments, patients with systemic lupus erythematosus (SLE) now have longer survival times, and factors involved in cumulative chronic damage in SLE need to be better understood. This study was undertaken to evaluate the relationship between smoking and cumulative chronic damage in SLE patients.
  
  
  METHODS
  A cross-sectional study of SLE patients was performed to investigate the possible association between smoking exposure (ever [previous or current, active or secondhand smokers] or never) and cumulative chronic damage as measured by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI). A systematic review of the literature was conducted by cross-searching Medline for the terms lupus and smoking.
  
  
  RESULTS
  We enrolled 105 patients with SLE (96% female), with a mean ± SD age of 40.7 ± 11.4 years and a mean followup time of 8.98 years. Of the 105 patients, 74 had an SDI score of 1-10, and 31 had an SDI score of 0. The difference between smoking exposure and no smoking exposure was significant (P = 0.02 by chi-square test in contingency table analysis), and SLE patients who were never exposed to smoking had 0.78 times the risk of progressing toward a cumulative damage status (SDI score of > 0) (95% confidence interval 0.16-0.98) throughout the followup period compared to those who were ever exposed. In the systematic review of the literature, we found only a small number of articles that addressed some aspects of the relationship between smoking exposure and cumulative damage in SLE patients.
  
  
  CONCLUSIONS
  Our findings indicate that smoking exposure is associated with cumulative chronic damage, as determined by the SDI score, in patients with SLE. Smoking exposure may have deleterious effects on lupus morbidity, and more detailed studies of this association are needed.
authors.affiliation: Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Ricardo A
authors.initials: RA
authors.lastname: Montes
authors.affiliation: Fluminense Federal University and Hospital Universitario Antonio Pedro, Niteroi, Brazil.
authors.forename: Luiz O
authors.initials: LO
authors.lastname: Mocarzel
authors.affiliation: Fluminense Federal University and Hospital Universitario Antonio Pedro, Niteroi, Brazil.
authors.forename: Pedro G
authors.initials: PG
authors.lastname: Lanzieri
authors.affiliation: Fluminense Federal University and Hospital Universitario Antonio Pedro, Niteroi, Brazil.
authors.forename: Lais M
authors.initials: LM
authors.lastname: Lopes
authors.affiliation: Fluminense Federal University and Hospital Universitario Antonio Pedro, Niteroi, Brazil.
authors.forename: Amanda
authors.initials: A
authors.lastname: Carvalho
authors.affiliation: Fluminense Federal University and Hospital Universitario Antonio Pedro, Niteroi, Brazil.
authors.forename: Jorge R
authors.initials: JR
authors.lastname: Almeida
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008180:Lupus Erythematosus, Systemic / Q000453:epidemiology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D012907:Smoking / Q000453:epidemiology*; D014028:Tobacco Smoke Pollution / Q000706:statistics & numerical data*
chemical_list: D014028:Tobacco Smoke Pollution