Relationship between Smoking and Clinical, Inflammatory and Radiographic Parameters in Patients with Ankylosing Spondylitis
Authors: Farouk Hanan M , Abdel-Rahman Maryam A , Hassan Rasha M , Nabil Mennat Allah M 
Published: August 2023

Abstract

Background
Axial spondyloarthritis (axSPA) are chronic often progressive inflammatory disorders of the axial skeleton including the sacroiliac joints. Patients suffer from pain, limited spinal mobility, functional disability and impaired psychological wellbeing. The prototype is Ankylosing spondylitis (AS) which is mainly associated with sacroiliac joint, spine, peripheral joints and entheses.

Aim of the Work
to investigate the relationship between smoking and each of clinical, inflammatory and radiographic parameters in patients with ankylosing spondylitis.

Patients and Methods
This a cross sectional study included 50 adult ankylosing spondylitis patients diagnosed according to the modified New York criteria, Attending to The outpatient clinic and the inpatients of Internal Medicine and Rheumatology Departments, Ain Shams University Hospitals and the outpatient clinic of Nasser Institute for Research and Treatment Hospital.

Results
Fifty patients were included in the study. In relation to smoking status, 27(54%) patients were never smoked, 20(40%) were current smokers and 3(6%) were past smokers. In the study they were divided into two groups, group I, the smokers included current smokers and group II, the non-smokers including past and never smokers. Comparisons of clinical, radiographic and acute phase reactants between smokers and non smokers AS patients showed a statistically significant decrease in chest expansion (p &lt; 0.001**) and increase in the occiput to wall distance (p &lt; 0.001**) in smokers than non-smokers. Regarding disease activity indices, it demonstrated that smokers had a significantly higher BASDAI (P &lt; 0.001**), BASFI (P &lt; 0.001**) and ASDAS (P &lt; 0.001**) compared with non smokers which reflects more functional disability and disease progression in smokers AS patients. Additionally, most of smokers had grade IV sacroiliitis while most of non-smokers had grade III. Also, there was a highly significant difference between the two groups as regards mSASSS (p &lt; 0.001**) which reflects more radiographic progression in smokers. Regarding acute phase reactants ESR (P = 0.029*) and CRP (P &lt; 0.001**), they were significantly higher in smokers in comparison with non-smokers.The correlations between for current smokers (pack/year) and clinical, laboratory and radiographic variables showed that smoking index was positively coorelated with BASFI (r = 0.568, p = 0.007*), ASDAS (r = 0.396, P = 0.046*) and mSASSS (r = 0.584, p = 0.005*) and negatively coorelated with chest expansion(r=-0.593, p = 0.005*).

Conclusions
current smoking is associated with higher disease activity, inflammatory markers, functional disability and radiological progression and this may interfere with personal daily activities, physical mobility and quality of life. Taking into account that smoking is a potentially modifiable lifestyle factor, AS smokers should be strongly advised to consider smoking cessation.