How Does Smoking Cessation Affect Disease Activity, Function Loss, and Quality of Life in Smokers With Ankylosing Spondylitis?

Seyhan Dülger, MD; İlknur Aykurt Karlıbel, MD; Meliha Kasapoğlu Aksoy, MD; Lale Altan, MD; Özlem Şengören Dikiş, MD; Tekin Yıldız, MD

Disclosures

J Clin Rheumatol. 2019;25(7):288-296. 

In This Article

Abstract and Introduction

Abstract

Background: Ankylosing spondylitis (AS) is a chronic systemic inflammatory disease that can progressively restrict spinal mobility.

Objective: This study aimed to investigate how smoking cessation by AS patients affects disease activity and their psychological state, physical mobility, lung function, and quality of life.

Materials and Methods: This was a longitudinal, single-blind, controlled, and observational study on 92 AS patients. Pulmonary function test, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Metrology Index, chest expansion, Short-Form 36, and Ankylosing Spondylitis Quality of Life were evaluated. The patients were divided into smokers (group 1 = 54) and nonsmokers (group 2 = 38). The smokers were divided further into subgroups of those who quit smoking (group 1a = 17) and those who did not (group 1b = 37). Groups 1a and 1b patients were compared in terms of their baseline data and data 6 months after smoking cessation. In addition, group 1a patients' baseline data and data 6 months after smoking cessation were compared statistically.

Results: There was no statistically significant difference between groups 1a and 1b after 6 months in terms of the evaluated parameters, except for BASDAI. Bath Ankylosing Spondylitis Disease Activity Index was significantly lower in group 1a than group 1b (p = 0.02), indicating that. When the baseline data and data after 6 months of group 1a were compared, a significant improvement was found in BASDAI (p = 0.001), Bath Ankylosing Spondylitis Functional Index (p = 0.001), chest expansion (p = 0.001), ankylosing spondylitis quality of life (p = 0.003), and subparameters physical function (p = 0.015), physical role strength (p = 0.05), power/live/vitality (p = 0.025), social functioning (p = 0.039), pain (p = 0.036), and general health perception (p = 0.05) of Short-Form 36, as well as forced expiratory volume in the first second (p = 0.003) and forced vital capacity (p = 0.007).

Conclusions: We observed significant improvements in disease activity, physical mobility, and quality of life in AS patients who quit smoking.

Introduction

Ankylosing spondylitis (AS) is a chronic systemic inflammatory disease that affects primarily the sacroiliac joints, spine, peripheral joints, and entheses, and can progressively restrict spinal mobility.[1] Loss of functional capacity due to the disease may lead to reduced quality of life.[2]

Previous studies in AS patients have found smoking to be associated with increased disease activity, poorer quality of life, and increased functional disability.[3,4] One study demonstrated that smoking causes progression of structural damage in axial spondyloarthritis,[5] another study established its association with not only progression but also pathogenesis. Smoking intensity can also be a major risk factor for AS.[6]

Ankylosing spondylitis limits the expansion of the chest by affecting costosternal and costovertebral joints, thereby leading to restrictive respiratory distress.[7] Pleuropulmonary tissue was also found to be a possible primary target of AS, and fibrosis could develop because of inflammatory processes in the lung parenchyma in AS patients.[8] Regardless of etiology, smoking has a negative effect on patients with restrictive respiratory distress.[9]

Although the influence of cigarette smoking on disease outcome is still unknown, an interaction between smoking and inflammation has been confirmed.[10] In smokers, an increased proinflammatory cytokine production and a decreased anti-inflammatory cytokine level has been observed. This inhibitory effect is thought to be due to the direct toxic effect of nicotine. Smoking can also lead to an increase in pain level with the indirect toxic effects of nonspecific tissue damage due to vasoconstriction or hypoxia.[11] Although these findings offer evidence on the importance of smoking cessation in improving long-term outcomes for AS patients, to our knowledge, there is a lack of study that focuses specifically on this subject. Therefore, we aimed to investigate how smoking cessation by AS patients affects disease activity and their psychological state, physical mobility, lung function, and quality of life.

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