POS0965 ARE SMOKING AND ALCOHOL ASSOCIATED WITH PERIPHERAL MUSCULOSKELETAL INVOLVEMENT IN PATIENTS WITH SPONDYLOARTHRITIS? RESULTS FROM THE ASAS-PERSPA STUDY
Authors: M. L. Ladehesa Pineda, R. Ortega Castro, M. Á. Puche Larrubia, M. Dougados, E. Collantes Estevez, C. López-Medina
Journal: Annals of the Rheumatic Diseases (2021)

Background: The harmful effect of smoking on axial spondyloarthritis (axSpA) in relation to radiographic progression is well known, but there are controversies around the role of cigarettes in other manifestations of SpA, such as peripheral involvement. Besides, it has been observed an inverse association between alcohol consumption and disease activity and functional impairment 1 , although it is still unclear its association with peripheral manifestations of SpA. Objectives: To evaluate the association between smoking/alcohol intake and the prevalence of peripheral articular manifestations (arthritis, enthesitis or dactylitis). To assess the association between smoking/alcohol intake and the location of such manifestations. Methods: Patients from the cross-sectional ASAS-PerSpA study with available data for both the smoking status and alcohol intake were included. Mixed logistic regressions using the peripheral manifestation (or location) as dependent variable, the smoking status or alcohol intake as fixed effect and the country as random effect were used. The interaction between smoking and alcohol was tested. Results: A total of 4451 patients with either axSpA, peripheral SpA or Psoriatic Arthritis were included. 59.5% had smoked at any moment and 42.7% had been alcohol drinkers. Patients who had ever suffered arthritis showed lower frequency of smoking habit (OR 0.72, 95%CI 0.63-0.82) and lower alcohol intake (OR 0.82, 95%CI 0.71-0.94) (Table 1). Among patients with arthritis, smoking was associated with predominantly upper limbs vs. lower limbs involvement (OR 0.78, 95%CI 0.65-0.94), while alcohol was associated with predominant mono/oligoarticular vs. polyarticular involvement (OR 1.13, 95%CI 0.94-1.36). Patients who had ever suffered enthesitis also showed lower frequency of smoking habit and alcohol intake (OR 0.75, 95%CI 0.63-0.89 and OR 0.69, 95%CI 0.57-0.83, respectively). No association was found with regard to the prevalence of dactylitis. At the moment of the study visit, 20.4% patients were current smokers and 32.2% consumed alcohol. Current alcohol intake was associated with lower prevalence of current arthritis (26.9% vs. 33.6% (OR 0.76, 95%CI 0.64-0.91) and current enthesitis (21.1% vs. 34.6% (OR 0.78, 95%CI 0.62-0.96), while current smoking did not show significant differences. No interaction was found in the association between alcohol and tobacco with regard to the prevalence of peripheral symptoms in the past. However, when assessing current arthritis, current smoking and no drinking was associated with arthritis in the lower limbs. Conclusion: These results suggest that, taking into account the country, smoking and alcohol are associated with lower prevalence of peripheral manifestations (arthritis and enthesitis), with no interaction effect between both habits. Smoking seems to be associated with predominantly upper limbs arthritis while alcohol intake seems to be associated with a predominantly oligo/mono articular involvement. Future studies are required including the influence of psoriasis and psoriatic arthritis in the relationship between alcohol and smoking and its association with peripheral manifestations. References: [1]Zhao S, Thong D, Duffield SJ, et al. Alcohol and disease activity in axial spondyloarthritis: a cross-sectional study. Rheumatol Int 2018. 38(3):375-381. Table 1. Association between peripheral musculoskeletal manifestations and smoking and alcohol. Peripheral joint disease with objective signs in the past Peripheral enthesitis with objective signs in the past Dactylitis in the past Yes 2292 No 2169 OR (95%CI)* Yes 765 No 3696 OR (95%CI)* Yes 685 No 3776 OR (95%CI)* Smoker ever 887 (38.7%) 1013 (46.7%) OR 0.72 312 (40.8%) 1588 (43.0%) OR 0.75 277 (40.4%) 1623 (43.0%) OR 0.89 (0.63-0.82 ) (0.63-0.89 ) (0.75-1.06) Alcohol ever 929 (40.4%) 882 (40.7%) OR 0.82 276 (36.1%) 1535 (41.5%) OR 0.69 299 (43.6%) 1512 (40.0%) OR 1.01 (0.71-0.94 ) (0.57-0.83 ) (0.84–1.22) *Mixed logistic regression using the country as a random effect. Disclosure of Interests: None declared.