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Clinical Rheumatology

, Volume 37, Issue 6, pp 1605–1616 | Cite as

Smoking quantity determines disease activity and function in Chinese patients with ankylosing spondylitis

  • Hui Zhang
  • Wei Wan
  • Jing Liu
  • Shengming Dai
  • Yaohong Zou
  • Qiaoxia Qian
  • Yue Ding
  • Xia Xu
  • Hengdong Ji
  • Hongjun He
  • Qi Zhu
  • Chengde Yang
  • Shuang Ye
  • Lindi Jiang
  • Jianping Tang
  • Qiang Tong
  • Dongyi He
  • Dongbao Zhao
  • Yuan Li
  • Yanyun Ma
  • Jingru Zhou
  • Zhendong Mei
  • Xiangxiang Chen
  • Ziyu Yuan
  • Juan Zhang
  • Xiaofeng Wang
  • Yajun Yang
  • Li Jin
  • Ying Gao
  • Xiaodong Zhou
  • John D. Reveille
  • Hejian Zou
  • Jiucun Wang
Original Article

Abstract

The objective of this study was to systemically and comprehensively evaluate the associations between smoking and disease outcomes in patients with ankylosing spondylitis (AS). Information on smoking, clinical features, and sociodemographic characteristics was collected by a questionnaire administered directly to the patient. Group differences were analyzed by t test or chi-square test. Logistic regression analysis was conducted with the Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), C-reactive protein, and erythrocyte sedimentation rate as the dependent variables and different stratification of smoking duration, smoking intensity, and cumulative smoking as independent variables. In order to compare our results with previous studies, meta-analysis was performed to calculate standardized mean difference (SMD) for relationship between outcomes and smoking status. A total of 1178 AS patients were analyzed. Compared with non-smokers, the risk of having active disease (BASDAI ≥ 4) was higher in patients who smoked at least 15 years, or 15 cigarettes per day, or 15 pack-years (OR = 1.70 [1.06, 2.73], 1.75 [1.08, 2.82], and 1.97 [1.06, 3.67], respectively); and smokers had increasing risk of BASDAI ≥ 4 with increasing years of smoking, or cigarettes per day, or pack-years (p-trend = 0.010, 0.008 and 0.006, respectively). The risk of having active disease was higher in patients who smoked at least 15 cigarettes per day or 15 pack-years (OR = 1.74 [1.06, 2.84] and 2.89 [1.56, 5.35], respectively), with increasing number of cigarettes per day and pack-years. Smokers had an increased risk of BASFI ≥ 4 (p-trend = 0.040 and 0.007, respectively). By meta-analysis, current, former and ever smokers had significantly higher BASDAI (SMD = 0.34 [0.18, 0.48], 0.10 [0.01, 0.19], and 0.27 [0.20, 0.34], respectively) and BASFI (SMD = 0.35 [0.16, 0.55], 0.30 [0.22, 0.39], and 0.35 [0.21, 0.50], respectively) compared to non-smokers. Smoking is a risk factor for greater disease activity and worse functioning in AS patients.

Keywords

Ankylosing spondylitis Cumulative smoking exposure Outcomes Smoking duration Smoking intensity 

Notes

Acknowledgments

Computational support was provided by the High-End Computing Center located at Fudan University.

Funding information

The study was supported by research grants from the National Basic Research Program (2014CB541801), National Natural Science Foundation of China (31521003), Ministry of Sciences and Technology (2011BAI09B00), US NIH NIAID U01 (1U01AI090909), International S&T Cooperation Program of China (2013DFA30870), and 111 Project (B13016).

Compliance with ethical standards

This study was approved by the Ethics Committees of the School of Life Sciences of Fudan University, and informed consent was obtained from each participant.

Disclosures

None.

Supplementary material

10067_2018_4016_MOESM1_ESM.docx (193 kb)
ESM 1 (DOCX 193 kb)

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Copyright information

© International League of Associations for Rheumatology (ILAR) 2018

Authors and Affiliations

  • Hui Zhang
    • 1
  • Wei Wan
    • 2
  • Jing Liu
    • 1
  • Shengming Dai
    • 3
  • Yaohong Zou
    • 4
  • Qiaoxia Qian
    • 1
  • Yue Ding
    • 1
  • Xia Xu
    • 2
  • Hengdong Ji
    • 5
  • Hongjun He
    • 6
  • Qi Zhu
    • 7
  • Chengde Yang
    • 8
  • Shuang Ye
    • 9
  • Lindi Jiang
    • 10
  • Jianping Tang
    • 11
  • Qiang Tong
    • 3
  • Dongyi He
    • 7
  • Dongbao Zhao
    • 2
  • Yuan Li
    • 1
  • Yanyun Ma
    • 1
  • Jingru Zhou
    • 1
  • Zhendong Mei
    • 1
  • Xiangxiang Chen
    • 1
  • Ziyu Yuan
    • 12
  • Juan Zhang
    • 12
  • Xiaofeng Wang
    • 1
    • 12
  • Yajun Yang
    • 1
    • 12
  • Li Jin
    • 1
    • 12
  • Ying Gao
    • 13
  • Xiaodong Zhou
    • 14
  • John D. Reveille
    • 14
  • Hejian Zou
    • 15
    • 16
  • Jiucun Wang
    • 1
    • 12
    • 16
  1. 1.State Key Laboratory of Genetic Engineering, Collaborative Innovation Center for Genetics and Development, School of Life SciencesFudan UniversityShanghaiChina
  2. 2.Division of Rheumatology and ImmunologyChanghai HospitalShanghaiChina
  3. 3.Department of Rheumatology & ImmunologyShanghai Jiao Tong University Affiliated Sixth People’s HospitalShanghaiChina
  4. 4.Division of Rheumatology and ImmunologyWuxi People’s HospitalWuxiChina
  5. 5.Division of RheumatologyTaizhou People’s HospitalTaizhouChina
  6. 6.Division of RheumatologyTaixing People’s HospitalTaizhouChina
  7. 7.Institute of Arthritis Research, Shanghai Academy of Chinese Medical SciencesGuanghua Integrative Medicine HospitalShanghaiChina
  8. 8.Division of Rheumatology, Ruijin HospitalShanghai Jiaotong University Schools of MedicineShanghaiChina
  9. 9.Division of Rheumatology, Renji HospitalShanghai Jiaotong University Schools of MedicineShanghaiChina
  10. 10.Department of Rheumatology, Zhongshan HospitalFudan UniversityShanghaiChina
  11. 11.Division of Rheumatology and ImmunologyTongji Hospital of Tongji University School of MedicineShanghaiChina
  12. 12.Fudan-Taizhou Institute of Health SciencesTaizhouChina
  13. 13.Key Laboratory of Nutrition and Metabolism, Institute for Nutritional Sciences, Shanghai Institutes for Biological SciencesChinese Academy of SciencesShanghaiChina
  14. 14.University of Texas Health Science Center at HoustonHoustonUSA
  15. 15.Division of Rheumatology, Huashan HospitalFudan UniversityShanghaiChina
  16. 16.Institute of Rheumatology, Immunology, and AllergyFudan UniversityShanghaiChina

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