title: Cigarette smoking and the risk of primary Sjögren's syndrome: a nested case control study.
abstract: Smoking is reported to affect the risk of a number of chronic disorders, including rheumatic diseases. Previous cross-sectional studies have shown a lower frequency of smoking in patients with primary Sjögren's syndrome (pSS). The aim of this study was to investigate the impact of smoking and socioeconomic status on the risk of subsequent diagnosis of pSS in a nested case-control study.
  
  
  
  Participants in two large population-based health surveys who were later diagnosed with pSS were identified through linkage with the Malmö Sjögren's Syndrome Register. Matched controls were obtained from the health surveys.
  
  
  
  Sixty-three patients with pSS with pre-diagnostic data from the health surveys were identified. Current smoking was associated with a significantly lower risk of later being diagnosed with pSS (odds ratio (OR) 0.3; 95% CI 0.1-0.6). Furthermore, former smoking was associated with an increased risk of subsequent pSS diagnosis (OR 4.0; 95% CI 1.8-8.8) compared to never smoking. Similar results were found in a sub-analysis of patients with reported symptom onset after inclusion in the health surveys. Socioeconomic status and levels of formal education had no significant impact on the risk of later being diagnosed with pSS.
  
  
  
  In this nested case-control study, current smoking was associated with a reduced risk of subsequent diagnosis of pSS. In addition, former smoking was associated with an increased risk. Whether this reflects a biological effect of cigarette smoking or other mechanisms should be further investigated in future studies.
authors.affiliation: Department of Clinical sciences, Malmö, Rheumatology, Lund University, Malmö, Sweden. peterx.olsson@med.lu.se.|Department of Rheumatology, Skåne University Hospital, Lund University, Inga Marie Nilssons gata 32, 20502, Malmö, Sweden. peterx.olsson@med.lu.se.
authors.forename: Peter
authors.identifier: 0000-0001-7318-833X
authors.initials: P
authors.lastname: Olsson
authors.affiliation: Department of Clinical sciences, Malmö, Rheumatology, Lund University, Malmö, Sweden.|Department of Rheumatology, Skåne University Hospital, Lund University, Inga Marie Nilssons gata 32, 20502, Malmö, Sweden.
authors.forename: Carl
authors.initials: C
authors.lastname: Turesson
authors.affiliation: Department of Clinical sciences, Malmö, Rheumatology, Lund University, Malmö, Sweden.|Department of Rheumatology, Skåne University Hospital, Lund University, Inga Marie Nilssons gata 32, 20502, Malmö, Sweden.
authors.forename: Thomas
authors.initials: T
authors.lastname: Mandl
authors.affiliation: Department of Clinical sciences, Malmö, Rheumatology, Lund University, Malmö, Sweden.|Department of Rheumatology and Inflammation research, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Lennart
authors.initials: L
authors.lastname: Jacobsson
authors.affiliation: Department of Clinical sciences, Malmö, Rheumatology, Lund University, Malmö, Sweden.|Department of Rheumatology, Skåne University Hospital, Lund University, Inga Marie Nilssons gata 32, 20502, Malmö, Sweden.
authors.forename: Elke
authors.initials: E
authors.lastname: Theander
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D000073865:Cigarette Smoking / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D012307:Risk Factors; D012859:Sjogren's Syndrome / Q000453:epidemiology*
keywords: Epidemiology; Primary Sjögren’s syndrome; Risk factor; Smoking; Socio-economy