الفهرس 
Axial spondyloarthritis (axSpA)Only 14 pages are availabe for public view
 |  | from | 198 |  |  |
| | | from | 198 | | |
Abstract
Axial spondyloarthritis (axSPA) are chronic often progressive inflammatory disorders of the axial skeleton including the sacroiliac joints. Patients suffer from pain, limited spinal mobility, functional disability and impaired psychological wellbeing. The prototype is Ankylosing spondylitis (AS) which is mainly associated with sacroiliac joint, spine, peripheral joints and entheses.
Several studies have investigated the role of smoking in axial spondyloarthritis. In the majority of these studies smoking has been associated with increase disease activity, worse functional ability, poorer quality of life and more severe radiographic damage in patients with ankylosing spondylitis.
Chronic smoking increases the level of acute phase proteins especially C-reactive protein (CRP), indicative of a persisting low-grade systemic inflammation. It may also cause an increase in pain level via the indirect toxic effect of vasoconstriction or hypoxia induced non specific tissue damage.
Cigarette smoking affects both the humoral and cellular immune response. It was shown to augment the production of numerous pro-inflammatory cytokines such as TNF-α, IL-1, IL-6, IL-8, GM-CSF (Granulocyte-macrophage colony stimulating factors) and to decrease the levels of anti-inflammatory cytokines such as IL-10. This inhibitory effect of proinflammatory cytokines production is thought to be due to the direct toxic effect of nicotine.
Tobacco smoke via multiple mechanisms leads to elevated IgE concentrations and to the subsequent development of atopic diseases and asthma. It has also been shown activate macrophage and dendritic cell activity in many ways.
Smoking has been recognized to elevate fibrinogen levels, induce leukocytosis, and elevate important markers of inflammation and autoimmunity such as C-reactive protein, intercellular adhesion molecule-1 and E-selectin. Smoking has an immunosuppressive effect;it induces abnormalities in T cells, reduces the activity of natural killer cells and decreases serum levels of IgM and IgG. These modulations in both cellular and humoral immunity might contribute to the induction of autoimmune processes.
Smoking is a major cause of morbidity and mortality worldwide. It is associated with increased risk of psoriasis in axSpA and possibly also uveitis flares and IBD. EAMs, particularly when severe, can significantly impact quality of life and many other outcomes; therefore, risks should be highlighted to patients who continue to smoke. AS patients should be encouraged to stop smoking at every opportunity due to the many well-established harms.
Our study is a cross sectional study to investigate the relationship between smoking and each of clinical, inflammatory and radiographic parameters in patients with ankylosing spondylitis.
It included 50 adult ankylosing spondylitis patients diagnosed according to the modified New York criteria, Attending to The outpatient clinic and the inpatients of Internal Medicine and Rheumatology Departments, Ain Shams University Hospitals and the outpatient clinic of Nasser Institute for Research and Treatment Hospital.
The clinical examination done for all patients in this study includes Schober test, chest expansion, occiput to wall distance and Patrick’s (FABER) test. Radiographs of sacroiliac joints, lumbosacral and cervical spine including anteroposterior and lateral views were performed for the patients. Disease activity, functional index and spinal mobility were assessed using measurement of ESR and CRP, the BASDAI, BASFI, ASDAS and mSASSS.
Our study included 78% males and 22 % females, their ages ranged from 20 to 53 years with a mean age of 24.28±8.30. 12% of the total patients has family history of ankylosing spondylitis and 88% of them has not. Their disease duration ranged from 6 to 29 years with a mean 13.08±5.76 years. 40%of patients are current smokers, 6% of them are past smokers and 54%of them are never smokers. The smoking index for current smokers (1 pack year = 20 cigarettes /day for 1 year) was 1 to 18 years with a mean of 7.33±5.29.
The present study revealed that:
- Comparison between smokers and non-smokers AS patients as regarding clinical examination, there was a highly significant decrease in chest expansion and increase in occiput to wall distance in smokers which reflects more disease progression in smokers AS patients (P<0.001**).
- There is insignificantly difference between smokers and non-smokers regarding extra articular manifestation including uveitis, skin problems, oral ulcers and osteoporosis (P=0.662).
- ESR was statistically significant higher in smokers than non-smokers (p=0.029*) and CRP was highly statistically significant higher in smokers AS patients (p< 0.001**).
- Regarding disease activity indices, our study showed that smokers had highly statistically significant higher BASDAI, BASFI and ASDAS (p<0.001**) in smokers than in non-smokers AS patients.
- Regarding radiological assessment, in this study 38.5% of male patients and 9.1% of female patients had sacroiliitis of grade IV and this showed that males had statistically significant more radiographic progression than females (mSASSS, P=0.034*). Also the disease activity indices were significantly higher in male than in female patients [BASDAI (P<0.001**), BASFI (P<0.001**), ASDAS (P=0.005*)].
- Most of the smokers (50%) had grade IV sacroiliitis, while most of non-smokers (46.7%) had grade III. As regards mSASSS, there was a highly statistically significant more radiographic progression in smokers than non-smokers AS patients (p<0.001**).
- Also, there is a highly statistically significant positive correlations between disease activity indices (BASDAI and BASFI) and mSASSS and CRP (p<0.001**) and this means increasing CRP level is associated with increase disease activity and radiographic progression in AS patients.
- Our study showed that there is a statistically significant positive correlations between the smoking index with BASFI (r=0.568, p=0.007*), ASDAS (r=0.396, p=0.046*) and mSASSS (r=0.584, p=0.005*). A significant negative correlation was also noticed between it and chest expansion (r=-0.049, p=o.832). This reflects an increase in disease activity, functional disability and radiographic progression as the smoking index increases.
- Also, there is a statistically significant positive correlation between mSASSS and age of AS patients (r=0.297, P= 0.036*).