Associations between smoking and extra-axial manifestations and disease severity in axial spondyloarthritis: results from the BSR Biologics Register for Ankylosing Spondylitis (BSRBR-AS)

Sizheng Zhao, Gareth T Jones, Gary J Macfarlane, David M Hughes, Linda E Dean, Robert J Moots, Nicola J Goodson (Corresponding Author)

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objective: The effects of smoking on disease manifestations in axial SpA are inadequately described. Utilizing a large and well-characterized cohort, we investigated the association between smoking and extra-axial manifestations, and smoking and disease severity measures.

Methods: Baseline data from the British Society for Rheumatology Biologics Register for Ankylosing Spondylitis were explored. Our analyses focused on extra-axial manifestations and other disease severity measures, including scales for fatigue, sleep, anxiety and depression. Logistic and linear models were used to quantify associations between disease characteristics according to smoking status (current/ex/never) and quantity (heavy/light), adjusting for age, gender, BMI, education, deprivation, comorbidities, symptom duration and alcohol status.

Results: A total of 2031 participants were eligible for the current analysis (68% male, mean age 49 years). Of these, 24% were current and 32% ex-smokers. When compared with non-smokers, current smokers had lower odds of uveitis [OR 0.7, 95% CI 0.5-0.9] and higher odds of psoriasis (ORadj 1.6, 95% CI 1.1-2.3). Ex- and current smokers had incrementally more severe disease than never smokers, with higher BASDAI (β = 0.3, 95% CI 0.1-0.6; β = 0.9, 95% CI 0.6-1.2) and BASFI (β = 0.5, 95% CI 0.2-0.8; β = 1.3, 95% CI 1.0-1.6); similar associations were observed for fatigue, sleep, anxiety and depression.

Conclusion: In this large cross-sectional study, we observed that smoking is independently associated with an adverse disease profile in axial SpA, including worse fatigue, sleep, anxiety and depression, and higher odds of psoriasis. The paradoxical association between current smoking and reduced odds of uveitis is interesting and warrants further investigation.

Original languageEnglish
Pages (from-to)811-819
Number of pages9
JournalRheumatology
Volume58
Issue number5
Early online date14 Dec 2018
DOIs
Publication statusPublished - May 2019

Fingerprint

Ankylosing Spondylitis
Biological Products
Smoking
Fatigue
Sleep
Anxiety
Uveitis
Depression
Psoriasis
Comorbidity
Linear Models
Cross-Sectional Studies
Logistic Models
Alcohols
Education
Light

Keywords

  • axial spondyloarthritis
  • ankylosing spondylitis
  • smoking
  • uveitis
  • extra-axial manifestations
  • registry
  • fatigue
  • sleep
  • psoriasis
  • depression
  • Psoriasis
  • Depression
  • Fatigue
  • Registry
  • Sleep
  • Extra-axial manifestations
  • Uveitis
  • Axial spondyloarthritis
  • Ankylosing spondylitis
  • Smoking
  • SMOKERS
  • HEALTH
  • SCALE
  • CRITERIA
  • ARTHRITIS
  • DAMAGE
  • INFLAMMATORY-BOWEL-DISEASE
  • PSORIASIS
  • ONSET

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Rheumatology

Cite this

Associations between smoking and extra-axial manifestations and disease severity in axial spondyloarthritis : results from the BSR Biologics Register for Ankylosing Spondylitis (BSRBR-AS). / Zhao, Sizheng; Jones, Gareth T; Macfarlane, Gary J; Hughes, David M; Dean, Linda E; Moots, Robert J; Goodson, Nicola J (Corresponding Author).

In: Rheumatology, Vol. 58, No. 5, 05.2019, p. 811-819.

Research output: Contribution to journalArticle

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title = "Associations between smoking and extra-axial manifestations and disease severity in axial spondyloarthritis: results from the BSR Biologics Register for Ankylosing Spondylitis (BSRBR-AS)",
abstract = "Objective: The effects of smoking on disease manifestations in axial SpA are inadequately described. Utilizing a large and well-characterized cohort, we investigated the association between smoking and extra-axial manifestations, and smoking and disease severity measures.Methods: Baseline data from the British Society for Rheumatology Biologics Register for Ankylosing Spondylitis were explored. Our analyses focused on extra-axial manifestations and other disease severity measures, including scales for fatigue, sleep, anxiety and depression. Logistic and linear models were used to quantify associations between disease characteristics according to smoking status (current/ex/never) and quantity (heavy/light), adjusting for age, gender, BMI, education, deprivation, comorbidities, symptom duration and alcohol status.Results: A total of 2031 participants were eligible for the current analysis (68{\%} male, mean age 49 years). Of these, 24{\%} were current and 32{\%} ex-smokers. When compared with non-smokers, current smokers had lower odds of uveitis [OR 0.7, 95{\%} CI 0.5-0.9] and higher odds of psoriasis (ORadj 1.6, 95{\%} CI 1.1-2.3). Ex- and current smokers had incrementally more severe disease than never smokers, with higher BASDAI (β = 0.3, 95{\%} CI 0.1-0.6; β = 0.9, 95{\%} CI 0.6-1.2) and BASFI (β = 0.5, 95{\%} CI 0.2-0.8; β = 1.3, 95{\%} CI 1.0-1.6); similar associations were observed for fatigue, sleep, anxiety and depression.Conclusion: In this large cross-sectional study, we observed that smoking is independently associated with an adverse disease profile in axial SpA, including worse fatigue, sleep, anxiety and depression, and higher odds of psoriasis. The paradoxical association between current smoking and reduced odds of uveitis is interesting and warrants further investigation.",
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author = "Sizheng Zhao and Jones, {Gareth T} and Macfarlane, {Gary J} and Hughes, {David M} and Dean, {Linda E} and Moots, {Robert J} and Goodson, {Nicola J}",
note = "We are grateful to the staff of the BSRBR-AS register, who are currently Claudia Zabke, Elizabeth Ferguson-Jones, Maureen Heddle, Nafeesa Nazlee and Barry Morris, and to the recruiting staff at the clinical centres, details of which are available at: https://www.abdn.ac.uk/iahs/research/epidemiology/spondyloarthritis. SZ analysed the data and wrote the manuscript, with significant input from all co-authors. GJM and GTJ are Chief Investigator and Deputy Chief Investigator, respectively, on BSRBR-AS and designed the study and oversaw its conduct. In the current project, they discussed results and provided input into drafts of the manuscript. NJG and RJM contributed towards design of the current analysis and drafting of the manuscript. DMH and LED contributed towards statistical analyses and provided input into the manuscript. Funding: The BSRBR-AS is funded by the British Society for Rheumatology (BSR) who have received funding for this from Pfizer, AbbVie and UCB. These companies receive advance copies of manuscripts for comments. They have no input into determining the topics for analysis or work involved in undertaking it. Disclosure statement: The authors have declared no conflicts of interest. Supplementary data Supplementary data are available at Rheumatology online.",
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TY - JOUR

T1 - Associations between smoking and extra-axial manifestations and disease severity in axial spondyloarthritis

T2 - results from the BSR Biologics Register for Ankylosing Spondylitis (BSRBR-AS)

AU - Zhao, Sizheng

AU - Jones, Gareth T

AU - Macfarlane, Gary J

AU - Hughes, David M

AU - Dean, Linda E

AU - Moots, Robert J

AU - Goodson, Nicola J

N1 - We are grateful to the staff of the BSRBR-AS register, who are currently Claudia Zabke, Elizabeth Ferguson-Jones, Maureen Heddle, Nafeesa Nazlee and Barry Morris, and to the recruiting staff at the clinical centres, details of which are available at: https://www.abdn.ac.uk/iahs/research/epidemiology/spondyloarthritis. SZ analysed the data and wrote the manuscript, with significant input from all co-authors. GJM and GTJ are Chief Investigator and Deputy Chief Investigator, respectively, on BSRBR-AS and designed the study and oversaw its conduct. In the current project, they discussed results and provided input into drafts of the manuscript. NJG and RJM contributed towards design of the current analysis and drafting of the manuscript. DMH and LED contributed towards statistical analyses and provided input into the manuscript. Funding: The BSRBR-AS is funded by the British Society for Rheumatology (BSR) who have received funding for this from Pfizer, AbbVie and UCB. These companies receive advance copies of manuscripts for comments. They have no input into determining the topics for analysis or work involved in undertaking it. Disclosure statement: The authors have declared no conflicts of interest. Supplementary data Supplementary data are available at Rheumatology online.

PY - 2019/5

Y1 - 2019/5

N2 - Objective: The effects of smoking on disease manifestations in axial SpA are inadequately described. Utilizing a large and well-characterized cohort, we investigated the association between smoking and extra-axial manifestations, and smoking and disease severity measures.Methods: Baseline data from the British Society for Rheumatology Biologics Register for Ankylosing Spondylitis were explored. Our analyses focused on extra-axial manifestations and other disease severity measures, including scales for fatigue, sleep, anxiety and depression. Logistic and linear models were used to quantify associations between disease characteristics according to smoking status (current/ex/never) and quantity (heavy/light), adjusting for age, gender, BMI, education, deprivation, comorbidities, symptom duration and alcohol status.Results: A total of 2031 participants were eligible for the current analysis (68% male, mean age 49 years). Of these, 24% were current and 32% ex-smokers. When compared with non-smokers, current smokers had lower odds of uveitis [OR 0.7, 95% CI 0.5-0.9] and higher odds of psoriasis (ORadj 1.6, 95% CI 1.1-2.3). Ex- and current smokers had incrementally more severe disease than never smokers, with higher BASDAI (β = 0.3, 95% CI 0.1-0.6; β = 0.9, 95% CI 0.6-1.2) and BASFI (β = 0.5, 95% CI 0.2-0.8; β = 1.3, 95% CI 1.0-1.6); similar associations were observed for fatigue, sleep, anxiety and depression.Conclusion: In this large cross-sectional study, we observed that smoking is independently associated with an adverse disease profile in axial SpA, including worse fatigue, sleep, anxiety and depression, and higher odds of psoriasis. The paradoxical association between current smoking and reduced odds of uveitis is interesting and warrants further investigation.

AB - Objective: The effects of smoking on disease manifestations in axial SpA are inadequately described. Utilizing a large and well-characterized cohort, we investigated the association between smoking and extra-axial manifestations, and smoking and disease severity measures.Methods: Baseline data from the British Society for Rheumatology Biologics Register for Ankylosing Spondylitis were explored. Our analyses focused on extra-axial manifestations and other disease severity measures, including scales for fatigue, sleep, anxiety and depression. Logistic and linear models were used to quantify associations between disease characteristics according to smoking status (current/ex/never) and quantity (heavy/light), adjusting for age, gender, BMI, education, deprivation, comorbidities, symptom duration and alcohol status.Results: A total of 2031 participants were eligible for the current analysis (68% male, mean age 49 years). Of these, 24% were current and 32% ex-smokers. When compared with non-smokers, current smokers had lower odds of uveitis [OR 0.7, 95% CI 0.5-0.9] and higher odds of psoriasis (ORadj 1.6, 95% CI 1.1-2.3). Ex- and current smokers had incrementally more severe disease than never smokers, with higher BASDAI (β = 0.3, 95% CI 0.1-0.6; β = 0.9, 95% CI 0.6-1.2) and BASFI (β = 0.5, 95% CI 0.2-0.8; β = 1.3, 95% CI 1.0-1.6); similar associations were observed for fatigue, sleep, anxiety and depression.Conclusion: In this large cross-sectional study, we observed that smoking is independently associated with an adverse disease profile in axial SpA, including worse fatigue, sleep, anxiety and depression, and higher odds of psoriasis. The paradoxical association between current smoking and reduced odds of uveitis is interesting and warrants further investigation.

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KW - ankylosing spondylitis

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KW - uveitis

KW - extra-axial manifestations

KW - registry

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KW - sleep

KW - psoriasis

KW - depression

KW - Psoriasis

KW - Depression

KW - Fatigue

KW - Registry

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KW - Extra-axial manifestations

KW - Uveitis

KW - Axial spondyloarthritis

KW - Ankylosing spondylitis

KW - Smoking

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KW - HEALTH

KW - SCALE

KW - CRITERIA

KW - ARTHRITIS

KW - DAMAGE

KW - INFLAMMATORY-BOWEL-DISEASE

KW - PSORIASIS

KW - ONSET

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U2 - 10.1093/rheumatology/key371

DO - 10.1093/rheumatology/key371

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JO - Rheumatology

JF - Rheumatology

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