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Smokers in early axial spondyloarthritis have earlier disease onset, more disease activity, inflammation and damage, and poorer function and health-related quality of life: results from the DESIR cohort
  1. Ho Yin Chung1,2,
  2. Pedro Machado1,3,
  3. Désirée van der Heijde1,
  4. Maria-Antonietta D'Agostino4,
  5. Maxime Dougados5
  1. 1Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands
  2. 2Department of Rheumatology and Clinical Immunology, University of Hong Kong, Hong Kong, China
  3. 3Department of Rheumatology, Coimbra University Hospital, Coimbra, Portugal
  4. 4Department of Rheumatology, Ambroise Paré Hospital, Boulogne-Billancourt, France
  5. 5Rheumatology B Department, APHP, Cochin Hospital, Paris-Descartes University, Paris, France
  1. Correspondence to Professor Maxime Dougados, Rheumatology B Department, Cochin Hospital, Paris 75014, France; m.doug{at}


Objectives To investigate the association of smoking with various clinical, functional and imaging outcomes in patients with early axial spondyloarthritis (SpA).

Methods 647 patients with early inflammatory back pain (IBP) fulfilling at least one of the internationally accepted SpA criteria and with available smoking data were included in the analyses. Clinical, demographic and imaging parameters were compared between smokers and non-smokers at a cross-sectional level. Variables with significant differences in univariate analyses were used as dependent variables in multivariate linear and logistic regression models adjusted for potential confounding/contributing factors.

Results Multivariate analysis showed that smoking was associated with an earlier onset of IBP (regression coefficient (B)=(−1.46), p=0.04), higher disease activity (ankylosing spondylitis disease activity score B=0.20, p=0.03; Bath ankylosing spondylitis disease activity index B=0.50, p=0.003), worse functional status (Bath ankylosing spondylitis functional index B=0.38, p=0.02), more frequent MRI inflammation of the sacroiliac joints (OR 1.57, p=0.02) and the spine (OR 2.33, p<0.001), more frequent MRI structural lesions of the sacroiliac joints (OR 1.54, p=0.03) and the spine (OR 2.02, p=0.01), and higher modified Stoke ankylosing spondylitis spine score (B=0.54, p=0.03) reflecting radiographic structural damage of the spine. Smoking was also associated with poorer quality of life (Euro-quality of life questionnaire B=1.38, p<0.001, short form 36 physical B=(−4.89), p<0.001, and mental component score B=(−5.90), p<0.001).

Conclusion In early axial SpA patients, smoking was independently associated with earlier onset of IBP, higher disease activity, increased axial inflammation on MRI, increased axial structural damage on MRI and radiographs, poorer functional status and poorer quality of life.

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  • Funding The DESIR study is conducted as a Programme Hospitalier de Recherche Clinique (PHRC) with Assistance Publique–Hôpitaux de Paris as the sponsor. The DESIR study is also under the umbrella of the French Society of Rheumatology, which is also financially supporting the cohort. An unrestricted grant from Pfizer has been allocated for the first 5 years. PM was supported by the Fundação para a Ciência e a Tecnologia (FCT) grant SFRH/BD/62329/2009.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval The DESIR study was approved by the French Departmental Directorate of Health and Social Affairs (Directeur Départemental des Affaires Sanitaires et Sociales) and has obtained the approval of the appropriate local ethics committees. It was conducted in accordance with the Declaration of Helsinki and the guidance for good clinical practice (French version), 30 November 2006.

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