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

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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.

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Acknowledgments

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

Funding

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).

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Author notes

  1. Hui Zhang, Wei Wan and Jing Liu contributed equally to this work.

Authors and Affiliations

  1. State Key Laboratory of Genetic Engineering, Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Fudan University, Shanghai, China

    Hui Zhang, Jing Liu, Qiaoxia Qian, Yue Ding, Yuan Li, Yanyun Ma, Jingru Zhou, Zhendong Mei, Xiangxiang Chen, Xiaofeng Wang, Yajun Yang, Li Jin & Jiucun Wang

  2. Division of Rheumatology and Immunology, Changhai Hospital, Shanghai, China

    Wei Wan, Xia Xu & Dongbao Zhao

  3. Department of Rheumatology & Immunology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China

    Shengming Dai & Qiang Tong

  4. Division of Rheumatology and Immunology, Wuxi People’s Hospital, Wuxi, Jiangsu Province, China

    Yaohong Zou

  5. Division of Rheumatology, Taizhou People’s Hospital, Taizhou, Jiangsu Province, China

    Hengdong Ji

  6. Division of Rheumatology, Taixing People’s Hospital, Taizhou, Jiangsu Province, China

    Hongjun He

  7. Institute of Arthritis Research, Shanghai Academy of Chinese Medical Sciences, Guanghua Integrative Medicine Hospital, Shanghai, China

    Qi Zhu & Dongyi He

  8. Division of Rheumatology, Ruijin Hospital, Shanghai Jiaotong University Schools of Medicine, Shanghai, China

    Chengde Yang

  9. Division of Rheumatology, Renji Hospital, Shanghai Jiaotong University Schools of Medicine, Shanghai, China

    Shuang Ye

  10. Department of Rheumatology, Zhongshan Hospital, Fudan University, Shanghai, China

    Lindi Jiang

  11. Division of Rheumatology and Immunology, Tongji Hospital of Tongji University School of Medicine, Shanghai, China

    Jianping Tang

  12. Fudan-Taizhou Institute of Health Sciences, Taizhou, Jiangsu Province, China

    Ziyu Yuan, Juan Zhang, Xiaofeng Wang, Yajun Yang, Li Jin & Jiucun Wang

  13. Key Laboratory of Nutrition and Metabolism, Institute for Nutritional Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China

    Ying Gao

  14. University of Texas Health Science Center at Houston, Houston, TX, USA

    Xiaodong Zhou & John D. Reveille

  15. Division of Rheumatology, Huashan Hospital, Fudan University, Shanghai, China

    Hejian Zou

  16. Institute of Rheumatology, Immunology, and Allergy, Fudan University, Shanghai, China

    Hejian Zou & Jiucun Wang

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  1. Hui Zhang
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Zhang, H., Wan, W., Liu, J. et al. Smoking quantity determines disease activity and function in Chinese patients with ankylosing spondylitis. Clin Rheumatol 37, 1605–1616 (2018). https://doi.org/10.1007/s10067-018-4016-3

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