SP0088 HOW YOU KNOW IT IS SMART NOT TO SMOKE LIKE A CHIMNEY

Smoking is associated with a higher prevalence of many diseases. When a health professional is well informed of the risks of smoking in rheumatic diseases, the advice given to the patient about quitting smoking could be more effective. It is known that smokers in the general population have an increased frequency of elevated rheumatoid factor (RF). Since 1987, we have known that cigarette smoking is a risk factor for rheumatoid arthritis (RA), especially in men with RF-positive who are heavy smokers. Later, it could be verified that cigarette smoking is implicated in the pathogenesis of RA particularly when associated with antibodies, cyclic citrullinated peptides (ACPA) and the shared epitope. Smoking increases the risk of both subsets of RA with a more pronounced influence on the risk of ACPA positive RA. The polyclonal immune response against modified antigens in patients with RA is not exclusively citrulline-specific, carbamylation of antigens like vimentin could be involved in the pathogenesis of the disease. Thus, smoking is a risk factor for breaking tolerance to multiple autoantigens in RA. In RA patients, cigarette smoking correlated with an increased risk of joint erosions, extra-articular manifestations and cardiovascular disease, in addition to the established effects of longstanding disease activity on the risk of myocardial infarction and stroke. Systemic lupus erythematosus (SLE) is also associated with smoking. A strong and specific connection of current smoking and >10 pack-years of smoking with dsDNA+ SLE has been observed. In patients with SLE, smoking exposure has deleterious effects on lupus morbidity and is related to cumulative chronic damage. In mucocutaneous SLE, smoking have a negative impact on the efficacy of belimumab and a 2-fold decrease in the proportion of patients achieving cutaneous improvement with antimalarials. Published data indicate that smoking has a dose-dependent impact on structural damage progression in Ankylosing Spondylitis. In a large UK cohort, smoking was positively associated with the risk of psoriatic arthritis in the general population, but negatively associated among patients with psoriasis. In addition, smokers with psoriatic arthritis had a poorer response to TNFi”s compared to non-smokers. Regarding osteoporosis, smoking has been identified as a predictor of ten-year fracture risk in men and women, largely independent of the densitometric results. This finding has eventually lead to incorporation of this risk factor into FRAX®. The impact of smoking on bone status is mainly associated with the number of smoking years. In a few reports, it has been observed an association between smoking and carpal tunnel syndrome and inflammatory bowel disease. Finally, current smoking in patients with fibromyalgia is associated with greater pain, possibly as a function of depression. Disclosure of Interests: Antonio Naranjo Grant/research support from: Amgen, Consultant for: UCB, Speakers bureau: Amgen, UCB