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Smoking does not protect patients with axial spondyloarthritis from attacks of uveitis
  1. Sizheng Steven Zhao1,2,
  2. Gary J Macfarlane3,4,
  3. Gareth T Jones3,4,
  4. Karl Gaffney5,
  5. David M Hughes6,
  6. Robert J Moots1,2,
  7. Nicola J Goodson1,2
  1. 1 Musculoskeletal biology I, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
  2. 2 Department of Academic Rheumatology, Aintree University Hospital, Liverpool, UK
  3. 3 Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
  4. 4 Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
  5. 5 Department of Rheumatology, Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, UK
  6. 6 Departmentof Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
  1. Correspondence to Dr Nicola J Goodson, Department of Academic Rheumatology, Aintree University Hospital, Liverpool, UK; ngoodson{at}

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Acute anterior uveitis (AAU) is the the most common extra-axial manifestation in axial spondyloarthritis (axSpA) and can lead to visual impairment if untreated. Cross-sectional axSpA studies have consistently reported lower odds of AAU in current smokers than ex or never smokers,1 2 which is in contrast to higher AAU risk among smokers in the general population.3 One explanation for this apparent paradox is behaviour change; those with AAU may be more likely to quit smoking. However, this does not explain the higher odds of AAU in never smokers. Another possibility is that smoking is protective for AAU as it is for ulcerative colitis, which shares patho-aetiology with axSpA and AAU.4 If smoking is protective of AAU, it should also reduce the frequency of flares. We examined the impact of smoking status on the number of AAU episodes among patients with AAU.

The British Society for Rheumatology Biologics Register for Ankylosing Spondylitis …

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  • Handling editor Josef S Smolen

  • Contributors SZ analysed the data and wrote the manuscript, with significant input from all coauthors. GJM and GTJ are Chief Investigator and Deputy Chief Investigator, respectively, on BSRBR-AS and designed the study and oversaw its conduct. In the current project, they discussed results and provided input into drafts of the manuscript. NJG, KG, DMH and RJM contributed towards design of the current analysis and drafting of the manuscript.

  • Funding The BSRBR-AS is funded by the British Society for Rheumatology (BSR) who have received funding for this from Pfizer, AbbVie and UCB.

  • Disclaimer Pfizer, AbbVie and UCB receive advance copies of manuscripts for comments. They have no input in determining the topics for analysis or work involved in undertaking it.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.