Smoking Status and Cutaneous Manifestations Among Patients with Systemic Lupus Erythematosus (SLE) Open Access

Abstract

Active smoking is a known risk factor for SLE development and has also been shown to
cause significant cutaneous damage. In this pilot study we sought to evaluate the
association between smoking behaviors and the severity of cutaneous manifestations
among SLE patients. Our cross-sectional study was performed among lupus clinic
patients, all of whom had a physician's diagnosis of SLE. Patients were assessed using a
smoking questionnaire along with the Cutaneous Lupus Erythematosus disease Area and
Severity Index (CLASI). Logistic and ordinal logistic regression models were used to
estimate potential associations between smoking status and CLASI scores adjusting for
race, sun exposure, and secondhand smoke. Current smoking status did not significantly
increase the odds of more severe overall cutaneous manifestations (OR = 1.421, 95% CI
= 0.408, 4.945), but when the CLASI was stratified into activity and damage sections,
current smoking status was found to significantly increase the odds of having active skin
manifestations among patients with SLE (OR = 4.522, 95% CI = 1.066, 19.187).

Table of Contents

Table of Contents


I.
Introduction……………………………………………….………………….1

a. Lupus……………………………………………………………………...1
b. Smoking……………………………………………………………….......3
c. Cutaneous Manifestations of SLE…………………………………….......4
II.
Literature Review…..………………………………………………..............4
a. Proposed Mechanism………………………………………………...…....4
b. Cigarette smoking and SLE meta-analysis…………………………….….6
c. Association between smoking and SLE disease activity………….……...7
d. Animal Models………………………………..……………………….....8
e. Association between smoking and cutaneous manifestations of SLE ......9
f. Secondhand Smoke…………………………………………………......10
g. Specific Aims & Importance………………………………………....…11
h. Hypothesis………………………………………………………………11
III.
Methods………………………………………………………………….....12
a. Study Design……………………………………………………………12
i. Sample…………………………………………………………..12
ii. Recruitment……………………………………………………..13
iii. Procedures and Measures…..……………………………………13
iv. Confidentiality…………………………………………………..15
v. Informed Consent…………………………………………….…15
b. Data Analysis……………………………………………………………16
IV.
Results………………………………..……………………………………..18
V.
Discussion…………………………………….……………………………..20
a. Response………………………………………………………………....20
b. Interpretation of Results…………………………………………………21
c. Potential Bias…………………………………………………………….23
d. Limitations & Uncertainties……………………………………………...24
VI.
Conclusions…………………….…………………………………………....26
a. Summary…………………………………………………………………26
b. Recommendations………………………………………………………..26
VII.
References……………..………………………………………….…………27
VIII. Tables & Figures…………………………………………………..………..30
IX.
Appendix………………………………………………………………..…...36

About this Master's Thesis

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School	Rollins School of Public Health
Department	Environmental Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Medicine and Surgery Health Sciences, Epidemiology
Keyword	SLE manifestation cutaneous CLASI skin behaviors smoking Systemic Lupus Erythematosus
Committee Chair / Thesis Advisor	Darrow, Lyndsey, Emory University
Committee Members	Tolbert, Paige, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs Hospital or other health care provider

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