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Cigarette smoking and the risk of systemic lupus erythematosus, overall and by anti-double stranded DNA antibody subtype, in the Nurses' Health Study cohorts.
Ann Rheum Dis 2018; 77(2):196-202AR

Abstract

OBJECTIVES

Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease, subtyped according to clinical manifestations and autoantibodies. Evidence concerning cigarette smoking and SLE risk has been conflicting. We investigated smoking and SLE risk, overall and by anti-double stranded DNA (dsDNA) presence, in two prospective cohort studies.

METHODS

The Nurses' Health Study (NHS) enrolled 121 701 US female nurses in 1976; Nurses' Health Study II (NHSII) enrolled 116 430 in 1989. Lifestyle, environmental and medical data were collected through biennial questionnaires. Incident SLE was confirmed by medical record review. Cox regression models estimated HRs of SLE, overall and by dsDNA subtype, in association with time-varying smoking status and cumulative smoking pack-years through the 2-year cycle prior to diagnosis, controlling for potential confounders.

RESULTS

Among 286 SLE cases identified (159 in NHS (1978-2012) and 127 in NHSII (1991-2013)), mean age was 49.2 (10.3) years and 42% were dsDNA+ at SLE diagnosis. At baseline, 45% of women had ever smoked, 51% of whom currently smoked. Compared with never smokers, current smokers had increased dsDNA+ SLE risk (HR 1.86 (1.14-3.04)), whereas past smokers did not (HR 1.31 (0.85-2.00)). Women who smoked >10 pack-years (vs never) had an elevated dsDNA+ SLE risk (HR 1.60(95% CI 1.04 to 2.45)) compared with never smokers. No associations were observed between smoking status or pack-years and overall SLE or dsDNA- SLE.

CONCLUSION

Strong and specific associations of current smoking and >10 pack-years of smoking with dsDNA+ SLE were observed. This novel finding suggests smoking is involved in dsDNA+ SLE pathogenesis.

Authors+Show Affiliations

Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

28988206

Citation

Barbhaiya, Medha, et al. "Cigarette Smoking and the Risk of Systemic Lupus Erythematosus, Overall and By Anti-double Stranded DNA Antibody Subtype, in the Nurses' Health Study Cohorts." Annals of the Rheumatic Diseases, vol. 77, no. 2, 2018, pp. 196-202.
Barbhaiya M, Tedeschi SK, Lu B, et al. Cigarette smoking and the risk of systemic lupus erythematosus, overall and by anti-double stranded DNA antibody subtype, in the Nurses' Health Study cohorts. Ann Rheum Dis. 2018;77(2):196-202.
Barbhaiya, M., Tedeschi, S. K., Lu, B., Malspeis, S., Kreps, D., Sparks, J. A., ... Costenbader, K. H. (2018). Cigarette smoking and the risk of systemic lupus erythematosus, overall and by anti-double stranded DNA antibody subtype, in the Nurses' Health Study cohorts. Annals of the Rheumatic Diseases, 77(2), pp. 196-202. doi:10.1136/annrheumdis-2017-211675.
Barbhaiya M, et al. Cigarette Smoking and the Risk of Systemic Lupus Erythematosus, Overall and By Anti-double Stranded DNA Antibody Subtype, in the Nurses' Health Study Cohorts. Ann Rheum Dis. 2018;77(2):196-202. PubMed PMID: 28988206.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cigarette smoking and the risk of systemic lupus erythematosus, overall and by anti-double stranded DNA antibody subtype, in the Nurses' Health Study cohorts. AU - Barbhaiya,Medha, AU - Tedeschi,Sara K, AU - Lu,Bing, AU - Malspeis,Susan, AU - Kreps,David, AU - Sparks,Jeffrey A, AU - Karlson,Elizabeth W, AU - Costenbader,Karen H, Y1 - 2017/10/07/ PY - 2017/04/19/received PY - 2017/07/31/revised PY - 2017/09/15/accepted PY - 2017/10/11/pubmed PY - 2019/1/29/medline PY - 2017/10/9/entrez KW - health services research KW - smoking KW - systemic lupus erythematosus SP - 196 EP - 202 JF - Annals of the rheumatic diseases JO - Ann. Rheum. Dis. VL - 77 IS - 2 N2 - OBJECTIVES: Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease, subtyped according to clinical manifestations and autoantibodies. Evidence concerning cigarette smoking and SLE risk has been conflicting. We investigated smoking and SLE risk, overall and by anti-double stranded DNA (dsDNA) presence, in two prospective cohort studies. METHODS: The Nurses' Health Study (NHS) enrolled 121 701 US female nurses in 1976; Nurses' Health Study II (NHSII) enrolled 116 430 in 1989. Lifestyle, environmental and medical data were collected through biennial questionnaires. Incident SLE was confirmed by medical record review. Cox regression models estimated HRs of SLE, overall and by dsDNA subtype, in association with time-varying smoking status and cumulative smoking pack-years through the 2-year cycle prior to diagnosis, controlling for potential confounders. RESULTS: Among 286 SLE cases identified (159 in NHS (1978-2012) and 127 in NHSII (1991-2013)), mean age was 49.2 (10.3) years and 42% were dsDNA+ at SLE diagnosis. At baseline, 45% of women had ever smoked, 51% of whom currently smoked. Compared with never smokers, current smokers had increased dsDNA+ SLE risk (HR 1.86 (1.14-3.04)), whereas past smokers did not (HR 1.31 (0.85-2.00)). Women who smoked >10 pack-years (vs never) had an elevated dsDNA+ SLE risk (HR 1.60(95% CI 1.04 to 2.45)) compared with never smokers. No associations were observed between smoking status or pack-years and overall SLE or dsDNA- SLE. CONCLUSION: Strong and specific associations of current smoking and >10 pack-years of smoking with dsDNA+ SLE were observed. This novel finding suggests smoking is involved in dsDNA+ SLE pathogenesis. SN - 1468-2060 UR - https://www.unboundmedicine.com/medline/citation/28988206/Cigarette_smoking_and_the_risk_of_systemic_lupus_erythematosus_overall_and_by_anti_double_stranded_DNA_antibody_subtype_in_the_Nurses'_Health_Study_cohorts_ L2 - https://ard.bmj.com/cgi/pmidlookup?view=long&pmid=28988206 DB - PRIME DP - Unbound Medicine ER -