title: Smoking is Associated With Extra-intestinal Manifestations in Inflammatory Bowel Disease.
abstract: OBJECTIVE
  Smoking affects the course of disease in patients with ulcerative colitis (UC) and Crohn's disease (CD). We aimed to study the association between smoking and extra-intestinal manifestations (EIMs) in inflammatory bowel disease (IBD).
  
  
  METHODS
  We cross-sectionally explored the association between smoking and EIMs in IBD in three cohort studies: (1) the COIN study, designed to estimate healthcare expenditures in IBD; (2) the Groningen study, focused on cigarette smoke exposure and disease behaviour in IBD; and (3) the JOINT study, evaluating joint and back manifestations in IBD.
  
  
  RESULTS
  In the COIN, Groningen and JOINT cohorts, 3030, 797 and 225 patients were enrolled, of whom 16, 24 and 23.5% were current smokers, respectively. Chronic skin disorders and joint manifestations were more prevalent in smoking IBD patients than in non-smokers (COIN, 39.1 vs 29.8%, p <0.01; Groningen, 41.7 vs 30.0%, p <0.01) in both CD and UC. In the JOINT cohort, smoking was more prevalent in IBD patients with joint manifestations than in those without (30.3 vs 13.0%, p <0.01). EIMs appeared to be more prevalent in high- than in low-exposure smokers (56.0 vs 37.1%, p = 0.10). After smoking cessation, the prevalence of EIMs in IBD patients rapidly decreased towards levels found in never smokers (lag time: COIN cohort, 1-2 years; Groningen cohort, within 1 year).
  
  
  CONCLUSIONS
  There is a robust dose-dependent association between active smoking and EIMs in both CD and UC patients. Smoking cessation was found to result in a rapid reduction of EIM prevalence to levels encountered in never smokers.
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Severs
authors.affiliation: Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: S J H
authors.initials: SJ
authors.lastname: van Erp
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: M E
authors.initials: ME
authors.lastname: van der Valk
authors.affiliation: Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: M J J
authors.initials: MJ
authors.lastname: Mangen
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: H H
authors.initials: HH
authors.lastname: Fidder
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: van der Have
authors.affiliation: Department of Gastroenterology and Hepatology, VU University Medical Centre, Amsterdam, The Netherlands Department of Gastroenterology and Hepatology, Atrium-Orbis Medical Centre, Sittard, The Netherlands.
authors.forename: A A
authors.initials: AA
authors.lastname: van Bodegraven
authors.affiliation: Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: D J
authors.initials: DJ
authors.lastname: de Jong
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands.
authors.forename: C J
authors.initials: CJ
authors.lastname: van der Woude
authors.affiliation: Department of Gastroenterology and Hepatology, Atrium-Orbis Medical Centre, Sittard, The Netherlands.
authors.forename: M J L
authors.initials: MJ
authors.lastname: Romberg-Camps
authors.affiliation: Department of Gastroenterology and Hepatology, Diaconessenhuis, Leiden, The Netherlands.
authors.forename: C H M
authors.initials: CH
authors.lastname: Clemens
authors.affiliation: Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
authors.forename: J M
authors.initials: JM
authors.lastname: Jansen
authors.affiliation: Department of Gastroenterology and Hepatology, Slingeland Hospital, Doetinchem, The Netherlands.
authors.forename: P C
authors.initials: PC
authors.lastname: van de Meeberg
authors.affiliation: Department of Gastroenterology and Hepatology, Antonius Hospital, Nieuwegein, The Netherlands.
authors.forename: N
authors.initials: N
authors.lastname: Mahmmod
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Centre Amsterdam, Amsterdam,The Netherlands.
authors.forename: C Y
authors.initials: CY
authors.lastname: Ponsioen
authors.affiliation: Department of Gastroenterology and Hepatology, Reinier de Graaf Groep, Delft, The Netherlands.
authors.forename: C
authors.initials: C
authors.lastname: Bolwerk
authors.affiliation: Department of Gastroenterology and Hepatology, Meander Medical Centre, Amersfoort, The Netherlands.
authors.forename: J R
authors.initials: JR
authors.lastname: Vermeijden
authors.affiliation: Department of Gastroenterology and Hepatology, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: M J
authors.initials: MJ
authors.lastname: Pierik
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: P D
authors.initials: PD
authors.lastname: Siersema
authors.affiliation: Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Leenders
authors.affiliation: Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: A E
authors.initials: AE
authors.lastname: van der Meulen-de Jong
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: G
authors.initials: G
authors.lastname: Dijkstra
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, The Netherlands boldenbu@umcutrecht.nl.
authors.forename: B
authors.initials: B
authors.lastname: Oldenburg
mesh_terms: D000328:Adult; D001168:Arthritis / Q000209:etiology; D003093:Colitis, Ulcerative / Q000150:complications / Q000209:etiology / Q000473:pathology; D003424:Crohn Disease / Q000150:complications / Q000209:etiology / Q000473:pathology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications* / Q000209:etiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012871:Skin Diseases / Q000209:etiology; D012907:Smoking / Q000009:adverse effects*; D016540:Smoking Cessation
keywords: Inflammatory bowel disease; extra-intestinal manifestations; smoking