Effect of Tobacco Smoking on The Clinical, Histopathological, and Serological Manifestations of Sjögren's Syndrome.
OBJECTIVE
To assess the association of smoking habits with the clinical, serological, and histopathological manifestations of Sjögren's syndrome (SS) and non-Sjögren's sicca (non-SS sicca).


METHODS
Cross-sectional case-control study of 1288 patients with sicca symptoms (587 SS and 701 non-SS sicca) evaluated in a multi-disciplinary research clinic. Smoking patterns were obtained from questionnaire data and disease-related clinical and laboratory data were compared between current, past, ever, and never smokers.


RESULTS
Current smoking rates were 4.6% for SS patients compared to 14.1% in non-SS sicca (p = 5.17x10E-09), 18% in a local lupus cohort (p = 1.13x10E-14) and 16.8% in the community (p = 4.12x10E-15). Current smoking was protective against SS classification (OR 0.35, 95%CI 0.22-0.56, FDR q = 1.9E10-05), focal lymphocytic sialadenitis (OR 0.26, 95%CI 0.15-0.44, FDR q = 1.52x10E-06), focus score ≥1 (OR 0.22, 95%CI 0.13-0.39, FDR q = 1.43x10E-07), and anti-Ro/SSA(+) (OR 0.36, 95%CI 0.2-0.64, FDR q = 0.0009); ever smoking was protective against the same features and against anti-La/SSB(+) (OR 0.52, 95%CI 0.39-0.70, FDR q = 5.82x10E-05). Duration of smoking was inversely correlated with SS even after controlling for socioeconomic status, BMI, alcohol and caffeine consumption.


CONCLUSIONS
Current tobacco smoking is negatively and independently associated with SS, protecting against disease-associated humoral and cellular autoimmunity. The overall smoking rate amongst SS patients is significantly lower than in matched populations and the effects of smoking are proportional to exposure duration. In spite of the protective effects of tobacco on SS manifestations, it is associated with other serious comorbidities such as lung disease, cardiovascular risk and malignancy, and should thus be strongly discouraged in patients with sicca.
Department of Ophthalmology, Johns Hopkins University, Baltimore, Maryland, United States of America.|King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia.
Donald U
DU
Stone
Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, United States of America.
Dustin
D
Fife
Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, United States of America.
Michael
M
Brown
US Air Force 59th Medical Wing, Joint Base San Antonio-Lackland Air Force Base, San Antonio, Texas, United States of America.
Keith E
KE
Earley
Department of Oral Diagnosis and Radiology, University of Oklahoma College of Dentistry, Oklahoma City, Oklahoma, United States of America.
Lida
L
Radfar
Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America.
C Erick
CE
Kaufman
Department of Oral Pathology, University of Oklahoma College of Dentistry, Oklahoma City, Oklahoma, United States of America.
David M
DM
Lewis
Department of Oral Surgery, University of Minnesota School of Dentistry, Minneapolis, Minnesota, United States of America.
Nelson L
NL
Rhodus
Hennepin County Medical Center, Minneapolis, Minnesota, United States of America.
Barbara M
BM
Segal
Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, California, United States of America.
Daniel J
DJ
Wallace
Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, California, United States of America.
Michael H
MH
Weisman
Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, California, United States of America.
Swamy
S
Venuturupalli
Department of Oral Medicine, Carolinas Medical Center, Charlotte, North Carolina, United States of America.
Michael T
MT
Brennan
Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, United States of America.
Christopher J
CJ
Lessard
Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, United States of America.
Courtney G
CG
Montgomery
Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, United States of America.|Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America.|Department of Veterans Affairs Medical Center, Oklahoma City, Oklahoma, United States of America.
R Hal
RH
Scofield
Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, United States of America.
Kathy L
KL
Sivils
Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, United States of America.
Astrid
http://orcid.org/0000-0001-7744-2948
A
Rasmussen
D000328:Adult; D000368:Aged; D001323:Autoantibodies / Q000097:blood; D015415:Biomarkers; D001706:Biopsy; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D012859:Sjogren's Syndrome / Q000097:blood* / Q000175:diagnosis / Q000473:pathology*; D012907:Smoking / Q000009:adverse effects
D001323:Autoantibodies; D015415:Biomarkers