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John Alexander Gonzales, Annie Chou, Jennifer Rose-Nussbaumer, Vatinee Y Bunya, Lindsey Criswell, Caroline Shiboski, Thomas Lietman; Association Between Smoking and Sjögren’s Syndrome and Signs of Keratoconjunctivitis Sicca: Is Smoking Protective?. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4895.
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© ARVO (1962-2015); The Authors (2016-present)
Smoking has been associated with worse visual acuity and more severe disease in many ocular diseases and autoimmune diseases. We hypothesized that smoking would be associated with a higher odds of being classified as having Sjögren’s syndrome and worse features of keratoconjunctivitis sicca (KCS) in participants in the Sjögren’s International Collaborative Clinical Alliance (SICCA) Registry.
Cross-sectional study of 3,514 participants enrolled into the SICCA registry from 9 international research sites. Participants met at least one of five inclusion criteria to enter the registry (including abnormal serologic testing or having complaints of dry eyes or mouth). Past, current or never smoker status was obtained from a questionnaire. Participants received an ophthalmic examination to assess for features of KCS including ocular staining score (OSS), Schirmer 1, and tear break up time (TBUT). Mixed effects logistic regression was performed to determine how smoking status predicted signs of KCS as well as being classified as having Sjögren’s syndrome.
There were 2,072 participants (59%) who had never smoked, 1,092 (31.1%) who were past smokers, 330 (9.4%) current smokers, and 20 (0.6%) who did not report their smoking status. Compared to never smokers, current smokers had a significantly lower odds of being classified as Sjögren’s syndrome (OR = 0.39, 95% CI: 0.29 to 0.52, p =< 0.001). Additionally, current smokers had a statistically significant lower odds of having an abnormal OSS (OR = 0.60, 95% CI: 0.46 to 0.78, p < 0.001), abnormal Schirmer 1 score (OR = 0.68, 95% CI: 0.51 to 0.91, p = 0.01), and abnormal TBUT (OR = 0.38, 95% CI: 0.29 to 0.52, p < 0.001). We adjusted for the potential confounders of dry mouth symptoms and age.
Compared to never smokers, current smokers exhibited a significantly lower odds of being classified with Sjögren’s syndrome as well as exhibiting features of KCS, even after controlling for dry mouth symptoms and age. Smoking has been shown in other autoimmune conditions to be protective by immunomodulatory mechanisms mediated by nicotine. Future studies exploring the relationship between smoking/nicotine and SS would be helpful exploring this relationship.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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