Why smoking cessation should be promoted in systemic lupus erythematosus patients?

According to a new study, smoking is connected with higher B cell-activating factor (BAFF) and decreased interferon (IFN-) levels, as well as an increased frequency of arthritis, migraine, and Raynaud's phenomenon in individuals with Sysytemic Lupus Erythematosus (SLE).

This study was conducted by Warren David Raymond and team, results of which were published in Lupus Science & Medicine on 1st January, 2021.

Smoking increases the burden of cutaneous illness and organ damage in SLE, as well as the risk of early death. However, the impact of smoking on illness symptoms and cytokine levels in SLE patients is unknown. This study evaluated the features of SLE patients based on their smoking status and looked at the relationship between smoking and serum cytokine levels.

For this study a cross-sectional study of 99 individuals with SLE during a research visit to determine smoking status. Smoking status was compared across classification criteria (American College of Rheumatology Classification Criteria for SLE (ACR97)), disease activity (SLE Disease Activity Index), autoantibody levels, accrued damage (Systemic Lupus International Collaborating Clinics/ACR Damage Index), and serum interferon-gamma (IFN-y), interleukin (IL)-1, IL-4, IL-6, IL-10, IL-12, IL-17, BAFF. Adjusting for age and gender, clinical features, and anti-inflammatory (IL-4, IL-10, and TGF-1) and regulatory (IL-1) cytokines, linear regression models were used to examine the relationship between smoking and cytokine levels.

Key Findings:

1. 35.4% (n=35 of 99) of SLE patients smoked (an average of 7 cigarettes per day for 24 years).

2. Smokers were more likely to develop ACR97 malar rash and mucosal ulcers.

3. Smokers exhibited higher rates of arthritis, migraine, Raynaud's phenomenon, and usage of nonsteroidal anti-inflammatory drugs. Smoking was related with a 27% rise in BAFF levels and a 42% decrease in IFN- levels.

In conclusion, in SLE patients, smoking was related with higher serum BAFF and reduced IFN-. Smoking status was linked to a clinical phenotype that includes mucocutaneous characteristics, arthritis, migraine/lupus headaches, and secondary Raynaud's phenomenon, necessitating higher NSAID usage. To minimize systemic inflammation (BAFF and physician GDA), arthritis, vasospasticity, cutaneous characteristics, and NSAID necessity, smoking cessation should be promoted in SLE, while enhancing pharmaceutical efficacy (hydroxychloroquine) and innate immune competence.

Reference:

Raymond WD, Hamdorf M, Furfaro M, Eilertsen GO, Nossent JC. Smoking associates with increased BAFF and decreased interferon-γ levels in patients with systemic lupus erythematosus. Lupus Sci Med. 2021 Oct;8(1):e000537. doi: 10.1136/lupus-2021-000537. PMID: 34725185; PMCID: PMC8562512.