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John Alexander Gonzales, Jennifer Rose-Nussbaumer, Vatinee Y Bunya, Annie Chou, Lindsey Criswell, Caroline Shiboski, Thomas Lietman; The Effect of Smoking in the Sjögren's Syndrome International Collaborative Clinical Alliance Cohort. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2678.
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© ARVO (1962-2015); The Authors (2016-present)
The Sjögren’s International Collaborative Collective (SICCA) is an NIH- and NEI-funded multicenter prospective cohort study exploring the etiology, diagnosis and treatment of Sjögren’s syndrome (SS). Our group was responsible for the development of the American College of Rheumatology criteria for SS which requires satisfying diagnostic criteria including 1) serologic testing (positive anti-SSA/B or positive rheumatoid factor and ANA≥1:320); 2) ocular staining score (OSS) ≥ 3; 3) histologic testing (labial salivary gland biopsy with lymphocytic focus score > 1/mm2. Herein, we describe cigarette smoking and its relation to symptoms of dry eye and signs of keratoconjunctivitis sicca (KCS) in a large cohort of patients enrolled into the SICCA registry.
Patients enrolled into the SICCA registry between 2004 and 2010 completed baseline questionnaires and ocular examination. Mixed effects modeling was performed to determine if smoking predicted clinical signs of KCS or predicted patient-reported symptoms of dry eyes controlling for health, age, country of residence, and gender and allowing for non-independence within site (STATA 11.0 software, StataCorp LP, College Station, TX).
A total of 3,514 participants were enrolled into the SICCA registry and criteria for SS was met in 1,578 (44.9%) particpants while 1,831 (52.1%) particpants were negative for SS. There were 1,509 participants (42.9%) with SS positive KCS, 1,028 participants (29.3%) with SS negative KCS, and 977 participants (27.8%) without KCS. Current smokers had a lower odds of having a positive labial salivary gland biopsy in SS positve participants compared to those not currently smoking (OR=0.27, p<0.001, 95% CI: 0.62 to 0.86) and also had a lower odds of having KCS compared to those not currently smoking (OR=0.39, p<0.001, 95% CI: 0.16 to 0.45). In the SS negative cohort, past smokers had a nearly 1.5 times higher odds of dry eye symtpoms compared to those who had never smoked (OR = 1.49, p=0.03, 95% CI: 1.05 to 2.11).
Current and post smoking status in SS patients was not associated with signs of KCS or symptoms of dry eye, but current smoking was protective from having a labial salivary gland biopsy demonstrating focal lymphocytic sialadenitis. Likewise, in SS negative patients a past history of smoking was not associated with signs of KCS, but it was associated with symptoms of dry eye.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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