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Associations of cigarette smoking with disease phenotype and type I interferon expression in primary Sjogren's syndrome

Journal article
Authors P. Olsson
I. L. A. Bodewes
A. M. Nilsson
C. Turesson
Lennart T. H. Jacobsson
E. Theander
M. A. Versnel
T. Mandl
Published in Rheumatology International
Volume 39
Issue 9
Pages 1575-1584
ISSN 0172-8172
Publication year 2019
Published at Institute of Medicine, Department of Rheumatology and Inflammation Research
Pages 1575-1584
Language en
Keywords Sjogren's syndrome, Cigarette smoking, Interferon type I, Autoimmune diseases, tobacco, prevalence, signatures, Rheumatology
Subject categories Rheumatology and Autoimmunity


Several studies have shown a negative association between smoking and primary Sjogren's syndrome (pSS), and smoking may interfere with the immune response. The purpose of this study was to investigate if smoking affects disease activity and disease phenotype in pSS. In this cross-sectional study, consecutive pSS patients filled out the EULAR Sjogren's Syndrome Patient Reported Index (ESSPRI) form and a structured questionnaire regarding smoking habits. EULAR Sjogren's Syndrome Disease Activity Index (ESSDAI) scores were calculated and blood samples were analysed for type I interferon signature using RT-PCR. Of 90 patients (93% women, median age 66.5 years), 72% were type I IFN signature positive and 6, 42 and 53% were current, former and never smokers, respectively. No significant differences by smoking status were found regarding ESSDAI total score, activity in the ESSDAI domains or type I IFN signature. Patients with a higher cumulative cigarette consumption (>= median) had higher scores in ESSPRI total [5.0 (3.0-6.3) vs 8.0 (6.0-8.3); p < 0.01] and ESSPRI sicca and pain domains. Comparing type I IFN signature negative and positive patients, the latter had significantly lower activity in ESSDAI articular domain (7/25 vs 3/64; p < 0.01) and lower scores in ESSPRI total [7.7 (5.2-8.2) vs 6.0 (4.0-7.7); p = 0.04]. Smoking was not associated with disease phenotype although patients with a higher cumulative cigarette consumption had worse symptoms in some disease domains. Current smokers were few making it difficult to draw any firm conclusions about associations to current smoking.

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