Título: "Cigarette smoking, antiphospholipid antibodies and
vascular events in Systemic Lupus Erythematosus"
Autores: Johanna T Gustafsson, Iva Gunnarsson, Henrik Källberg, Susanne Pettersson, Agneta Zickert, Anna Vikerfors, Sonia Möller, Johan Rönnelid, Kerstin Elvin, Elisabet Svenungsson.
Gustafsson JT, Gunnarsson I, Källberg H, et al.
Ann Rheum Dis 2015; 74 :1537 – 1543.
Smoking can induce autoantibodies in persons who are genetically predisposed to rheumatoid arthritis. We investigated the association between smoking and antiphospholipid antibodies (aPL) in systemic lupus erythematosus (SLE), a question not previously addressed. Further, we explored the relationship between smoking, aPL and vascular events (arterial and venous, VE).
In this cross-sectional study, clinical evaluation and questionnaire data were collected from 367 prevalent SLE patients. At the same time, we measured aPL (anticardiolipin (aCL), anti- β 2 glycoprotein- 1(a β 2 GP1) antibodies IgG/IgM/IgA, and lupus anticoagulant (LA)), and a large set of other SLE- associated autoantibodies for comparison. Association analyses using logistic regression models with smoking, (ever, former and current with never as reference) and antibody status as outcome variable were performed. As a secondary outcome, we investigated the associations between aPL, smoking and VE.
In multivariable-adjusted models ever, and in particular former, cigarette smoking was associated with the most pathogenic aPL; LA, aCL IgG and a β 2 GP1 IgG. Other SLE-associated autoantibodies were not associated with smoking. The combination of smoking and aPL was strongly associated with VE. We noted a positive interaction between smoking-LA and smoking- ‘ triple aPL ’ positivity for previous VE.
We investigated a large set of commonly occurring autoantibodies in SLE, but only aPL were positively associated with a history of smoking. This association was especially apparent in former smokers. Among ever regular smokers who were aPL positive, we observed a strikingly high frequency of former VE. The underlying mechanisms and temporality between smoking, aPL and VE need further investigations.