Ruscitti Piero, Di Cola Ilenia, Berardicurti Onorina, Conforti Alessandro, Iacono Daniela, Pantano Ilenia, Rozza Gelsomina, Rossi Silvia, De Stefano Ludovico, Balduzzi Silvia, Vitale Antonio, Caso Francesco, Costa Luisa, Prete Marcella, Navarini Luca, Atzeni Fabiola, Guggino Giuliana, Perosa Federico, Cantarini Luca, Frediani Bruno, Montecucco Carlomaurizio, Ciccia Francesco, Giacomelli Roberto, Cipriani Paola
Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, delta 6 building, PO box 67100, L'Aquila, Italy.
Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy.
Clin Rheumatol. 2022 Mar;41(3):641-647. doi: 10.1007/s10067-021-05929-8. Epub 2021 Oct 11.
The objective of this study is to describe the possible prognostic impact of smoking habit on adult-onset Still's disease (AOSD) patients, by the assessment of clinical characteristics, life-threatening complications occurrence, and mortality in smokers than non-smokers. A multicentre retrospective study of prospectively followed-up AOSD patients included in Gruppo Italiano di Ricerca in Reumatologia Clinica e Sperimentale (GIRRCS) cohort was conducted. Out of 185 AOSD assessed patients, 45 smokers were identified. These showed a higher frequency of pericarditis (35.5% vs 16.4%, p = 0.011), pleuritis (33.3% vs 14.3%, p = 0.008), and abdominal pain (17.7% vs 6.4%, p = 0.035). Furthermore, smokers showed higher values of systemic score (6.4 ± 2.2 vs 5.4 ± 1.8, p = 0.004), an increased rate of macrophage activation syndrome (MAS) (28.9% vs 6.4%, p < 0.0001) and of parenchymal lung disease (17.7% vs 12.6%, p = 0.035). Although not significant, these patients more frequently experienced a poor prognosis (13.3% vs 4.3%, p = 0.074). Smoking habit predicted MAS occurrence in both univariate (HR: 5.98, 95% CI: 2.45-14.57, p < 0.0001) and multivariate regression models (HR: 6.21, 95% CI: 2.46-15.70, p < 0.0001). Smokers had a significant higher risk of parenchymal lung disease in both univariate (HR: 3.97, 95% CI: 1.43-11.02, p = 0.008) and multivariate regression models (HR: 3.90, 95% CI: 1.36-11.23, p = 0.012). Smoking habit also increased the risk of mortality in univariate regression model (HR: 4.25, 95% CI: 1.33-13.55, p = 0.015). Smoking habit resulted to be a negative prognostic factor on AOSD patients. Smokers were characterised by a higher frequency of serositis and higher values of systemic score. Additionally, these patients were more frequently burdened by MAS and parenchymal lung disease associated with a poor prognosis. Key points • Smoking habit resulted to be a negative prognostic factor on AOSD. • Smokers were characterised by an increased frequency of serositis and higher values of systemic score. • Cigarette exposure was associated with MAS and parenchymal lung disease in AOSD.
本研究的目的是通过评估吸烟者与非吸烟者的临床特征、危及生命并发症的发生情况及死亡率，描述吸烟习惯对成人斯蒂尔病（AOSD）患者可能产生的预后影响。我们对意大利临床与实验风湿病研究组（GIRRCS）队列中前瞻性随访的AOSD患者进行了一项多中心回顾性研究。在185例接受评估的AOSD患者中，确定了45例吸烟者。这些吸烟者的心包炎发生率更高（35.5% 对16.4%，p = 0.011）、胸膜炎发生率更高（33.3% 对14.3%，p = 0.008）以及腹痛发生率更高（17.7% 对6.4%，p = 0.035）。此外，吸烟者的全身评分更高（6.4 ± 2.2对5.4 ± 1.8，p = 0.004），巨噬细胞活化综合征（MAS）发生率增加（28.9% 对6.4%，p < 0.0001）以及实质性肺疾病发生率增加（17.7% 对12.6%，p = 0.035）。尽管差异不显著，但这些患者预后不良的情况更常见（13.3% 对4.3%，p = 0.074）。在单因素（HR：5.98，95% CI：2.45 - 14.57，p < 0.0001）和多因素回归模型（HR：6.21，95% CI：2.46 - 15.70，p < 0.0001）中，吸烟习惯均能预测MAS的发生。在单因素（HR：3.97，95% CI：1.43 - 11.02，p = 0.008）和多因素回归模型（HR：3.90，95% CI：1.36 - 11.23，p = 0.012）中，吸烟者患实质性肺疾病的风险显著更高。在单因素回归模型中，吸烟习惯也增加了死亡风险（HR：4.25，95% CI：1.33 - 13.55，p = 0.015）。吸烟习惯是AOSD患者的一个不良预后因素。吸烟者的特征是浆膜炎发生率更高且全身评分更高。此外，这些患者更常受到与预后不良相关的MAS和实质性肺疾病的困扰。要点 • 吸烟习惯是AOSD的一个不良预后因素。 • 吸烟者的特征是浆膜炎发生率增加且全身评分更高。 • 在AOSD中，接触香烟与MAS和实质性肺疾病相关。
