We assessed correlations of smoking habits and alcohol consumption with disease activity or damage in patients with systemic lupus erythematosus (SLE).
Methods
A total of 505 patients with SLE were enrolled in the Korean Lupus Network (KORNET) SLE registry from January 2014 to January 2016. Disease activity and organ damage were measured by the SLE Disease Activity Index 2000 (SLEDAI-2K) and the Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) damage index, respectively. Multivariate logistic regression analysis was used to analyze associations with cutaneous lesions.
Results
There were no differences in SLEDAI-2K and SLICC/ACR damage indices according to either smoking status or alcohol consumption. More frequent cutaneous damage was observed in current alcohol drinkers compared with non-current alcohol drinkers (p = 0.020). Cutaneous damage was significantly associated with alcohol consumption (odds ratio (OR) 4.048, 95% confidence interval (CI) 1.251–12.102, p = 0.020). Both low (1–5 glasses/week) and high (≥6 glasses/week) amounts of alcohol consumption had a significant impact on cutaneous damage compared with the absence of current alcohol consumption (p = 0.033 and p = 0.027, respectively). Pairwise comparison of alcohol consumption and smoking status with cutaneous damage showed that only alcohol consumption was significantly associated with the presence of cutaneous damage, compared with non-current alcohol consumption and non-current smoking (OR 3.513, 95% CI 1.130–10.920, p =0.030).
Conclusions
Current alcohol consumption, but not smoking, might influence the development of cutaneous damage in patients with SLE.
TsokosGC. Systemic lupus erythematosus. N Engl J Med2011; 365: 2110–2121.
2.
Wahren-HerleniusMDörnerT. Immunopathogenic mechanisms of systemic autoimmune disease. Lancet2013; 382: 819–831.
3.
WashioMHoriuchiTKiyoharaCet al.Smoking, drinking, sleeping habits, and other lifestyle factors and the risk of systemic lupus erythematosus in Japanese females: findings from the KYSS study. Mod Rheumatol2006; 16: 143–150.
4.
KiyoharaCWashioMHoriuchiTet al.Cigarette smoking, alcohol consumption, and risk of systemic lupus erythematosus: a case-control study in a Japanese population. J Rheumatol2012; 39: 1363–1370.
5.
CostenbaderKHKimDJPeerzadaJet al.Cigarette smoking and the risk of systemic lupus erythematosus: a meta-analysis. Arthritis Rheum2004; 50: 849–857.
6.
HardyCJPalmerBPMuirKRSuttonAJPowellRJ. Smoking history, alcohol consumption, and systemic lupus erythematosus: A case-control study. Ann Rheum Dis1998; 57: 451–455.
7.
GhaussyNOSibbittWLJrQuallsCR. Cigarette smoking, alcohol consumption, and the risk of systemic lupus erythematosus: a case-control study. J Rheumatol2001; 28: 2449–2453.
8.
FormicaMKPalmerJRRosenbergLMcAlindonTE. Smoking, alcohol consumption, and risk of systemic lupus erythematosus in the Black Women's Health Study. J Rheumatol2003; 30: 1222–1226.
9.
BengtssonAARylanderLHagmarLNivedOSturfeltG. Risk factors for developing systemic lupus erythematosus: a case-control study in southern Sweden. Rheumatology (Oxford)2002; 41: 563–571.
10.
GhaussyNOSibbittWJrBankhurstADQuallsCR. Cigarette smoking and disease activity in systemic lupus erythematosus. J Rheumatol2003; 30: 1215–1221.
11.
RubinRLHermansonTMBedrickEJet al.Effect of cigarette smoke on autoimmunity in murine and human systemic lupus erythematosus. Toxicol Sci2005; 87: 86–96.
12.
TurchinIBernatskySClarkeAESt-PierreYPineauCA. Cigarette smoking and cutaneous damage in systemic lupus erythematosus. J Rheumatol2009; 36: 2691–2693.
13.
Ekblom-KullbergSKautiainenHAlhaPLeirisalo-RepoMMiettinenAJulkunenH. Smoking, disease activity, permanent damage and dsDNA autoantibody production in patients with systemic lupus erythematosus. Rheumatol Int2014; 34: 341–5.
14.
AlarcónGSMcGwinGJrBartolucciAAet al.Lupus in minority populations, nature versus nurture. Systemic lupus erythematosus in three ethnic groups. IX. Differences in damage accrual. Arthritis Rheum2001; 44: 2797–2806.
15.
Becker-MerokANossentHC. Damage accumulation in systemic lupus erythematosus and its relation to disease activity and mortality. J Rheumatol2006; 33: 1570–1577.
16.
GladmanDGinzlerEGoldsmithCet al.Systemic lupus international collaborative clinics: development of a damage index in systemic lupus erythematosus. J Rheumatol1992; 19: 1820–1821.
17.
GladmanDGinzlerEGoldsmithCet al.The development and initial validation of the Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index for systemic lupus erythematosus. Arthritis Rheum1996; 39: 363–369.
18.
TanEMCohenASFriesJFet al.The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum1982; 25: 1271–1277.
19.
HochbergMC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum1997; 40: 1725–1725.
20.
MakATaySH. Environmental factors, toxicants and systemic lupus erythematosus. Int J Mol Sci2014; 15: 16043–16056.
21.
BarbhaiyaMCostenbaderKH. Environmental exposures and the development of systemic lupus erythematosus. Curr Opin Rheumatol2016; 28: 497–505.
22.
TakvorianSUMerolaJFCostenbaderKH. Cigarette smoking, alcohol consumption and risk of systemic lupus erythematosus. Lupus2014; 23: 537–544.
23.
BermudezEARifaiNBuringJEMansonJERidkerPM. Relation between markers of systemic vascular inflammation and smoking in women. Am J Cardiol2002; 89: 1117–1119.
24.
MoszczynskiPZabinskiZMoszczynskiPJrRutowskiJSlowinskiSTabarowskiZ. Immunological findings in cigarette smokers. Toxicol Lett2001; 118: 121–127.
25.
Bourré-TessierJPeschkenCABernatskySet al.Association of smoking with cutaneous manifestations in systemic lupus erythematosus. Arthritis Care Res (Hoboken)2013; 65: 1275–1280.
26.
ViláLMAlarcónGSMcGwinGJret al.Early clinical manifestations, disease activity and damage of systemic lupus erythematosus among two distinct US Hispanic subpopulations. Rheumatology (Oxford)2004; 43: 358–363.
27.
SutcliffeNClarkeAEGordonCFarewellVIsenbergDA. The association of socio-economic status, race, psychosocial factors and outcome in patients with systemic lupus erythematosus. Rheumatology (Oxford)1999; 38: 1130–1137.
28.
KarlsonEWDaltroyLHLewRAet al.The relationship of socioeconomic status, race, and modifiable risk factors to outcomes in patients with systemic lupus erythematosus. Arthritis Rheum1997; 40: 47–56.
29.
WardMMStudenskiS. Clinical prognostic factors in lupus nephritis. The importance of hypertension and smoking. Arch Intern Med1992; 152: 2082–2088.
30.
Calvo-AlénJTolozaSMFernándezMet al.Systemic lupus erythematosus in a multiethnic US cohort (LUMINA). XXV. Smoking, older age, disease activity, lupus anticoagulant, and glucocorticoid dose as risk factors for the occurrence of venous thrombosis in lupus patients. Arthritis Rheum2005; 52: 2060–2068.
31.
McAlindonTGiannottaLTaubND'CruzDHughesG. Environmental factors predicting nephritis in systemic lupus erythematosus. Ann Rheum Dis1993; 52: 720–724.
32.
WangJPanHFYeDQSuHLiXP. Moderate alcohol drinking might be protective for systemic lupus erythematosus: a systematic review and meta-analysis. Clin Rheumatol2008; 27: 1557–1563.
33.
MandrekarPCatalanoDWhiteBSzaboG. Moderate alcohol intake in humans attenuates monocyte inflammatory responses: inhibition of nuclear regulatory factor kappa B and induction of interleukin 10. Alcohol Clin Exp Res2006; 30: 135–9.
34.
FenechMStockleyCAitkenC. Moderate wine consumption protects against hydrogen peroxide-induced DNA damage. Mutagenesis1997; 12: 289–296.
35.
ImhofAFroehlichMBrennerHBoeingHPepysMBKoenigW. Effect of alcohol consumption on systemic markers of inflammation. Lancet2001; 357: 763–767.
FukuiHBraunerBBodeJCBodeC. Plasma endotoxin concentrations in patients with alcoholic and non-alcoholic liver disease: reevaluation with an improved chromogenic assay. J Hepatol1991; 12: 162–169.
38.
EngsRCAldo-BensonM. The association of alcohol consumption with self-reported illness in university students. Psychol Rep1995; 76: 727–736.
39.
FrancèsCNiangSLaffitteEPelletierFlCostedoatNPietteJC. Dermatologic manifestations of the antiphospholipid syndrome: two hundred consecutive cases. Arthritis Rheum2005; 52: 1785–1793.
