Cigarette smoking and radiographic progression in rheumatoid arthritis
Cigarette smoking and radiographic progression in rheumatoid arthritis
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DOI：
10.1136/ard.2006.065060
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发表时间：
2007-08-01
影响因子：
27.4
通讯作者：
Gabay, C.
中科院分区：
文献类型：
--
作者：
Finckh, A.;Dehler, S.;Gabay, C.
背景：吸烟是类风湿性关节炎（RA）发展的一个公认的环境危险因素。然而，目前尚不清楚吸烟是否影响RA疾病的进展，以及吸烟者是否有更多的放射学损害进展比非吸烟者随着时间的推移。Objective：比较放射学损害进展率在当前吸烟者和非吸烟者在一个大型的前瞻性RA coherent.Methods：SCQM-RA是一个基于人口的登记监测疾病活动，放射学损害和症状，在定期。纳入了SCQM-RA数据库中具有连续平片的所有患者。采用经验证的评分方法对38个手足关节的关节侵蚀进行了评估。侵蚀进展率进行了分析，采用多变量纵向回归模型和调整潜在的confers.Results：2004年RA患者的平均3.6个连续的X光片和3.1年的随访。545名（27%）目前吸烟者平均每天吸烟16支，平均既往吸烟暴露量为20.6包-年。目前吸烟者和非吸烟者的放射学关节损伤进展率相似（p= 0.26）。然而，吸烟强度与显著的反向剂量反应相关;重度吸烟者（> 1包-天）的进展显著低于非吸烟者或中度吸烟者（p < 0.001）。此外，在重度吸烟者中观察到放射学进展减少和通常更有利的功能评分的显著趋势，表明香烟烟雾不会加速RA疾病进展。
Background: Smoking is a well-established environmental risk factor for the development of rheumatoid arthritis (RA). However, it remains unclear whether smoking influences RA disease progression and whether smokers have more radiographic damage progression than non-smokers over time.Objective: To compare the rates of radiographic damage progression in current smokers and non-smokers in a large prospective RA cohort.Methods: The SCQM-RA is a population- based registry monitoring disease activity, radiographic damage and symptoms at regular intervals. All patients in the SCQM-RA database with sequential plain radiographs were included. Joint erosions were assessed in 38 hand and foot joints with a validated scoring method. The rate of erosion progression was analysed using multivariate longitudinal regression models and adjusted for potential confounders.Results: 2004 RA patients with a mean of 3.6 sequential radiographs and 3.1 years of follow-up were included. The 545 (27%) current smokers smoked on average 16 cigarettes per day and had a mean past smoking exposure of 20.6 pack-years. Radiographic joint damage progressed at a similar rate in current smokers and non- smokers (p= 0.26). However, smoking intensity was associated with a significant inverse dose - response; heavy smokers (> 1 pack-day) progressed significantly less than non- smokers or moderate smokers (p < 0.001).Conclusion: Radiographic joint damage progressed at an equivalent rate in smokers and non- smokers. Furthermore, a significant trend was observed for reduced radiographic progression and generally more favourable functional scores among heavy smokers, suggesting that cigarette smoke does not accelerate RA disease progression.