Bandeira Matilde, Fisher Benjamin A
Rheumatology Department, Unidade Local de Saúde Santa Maria, Lisboa; Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Portugal; and Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, UK.
Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, and National Institute of Health Research (NIHR) Birmingham Biomedical Research Centre and Department of Rheumatology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Clin Exp Rheumatol. 2024 Dec;42(12):2346-2356. doi: 10.55563/clinexprheumatol/efbdo3. Epub 2024 Dec 19.
Unlike other autoimmune diseases, little is known about the environmental risk factors for Sjögren's disease (SjD). Smoking is an important risk factor for rheumatoid arthritis but the relationship between smoking and SjD is more complex to understand. Current smoking seems to be negatively linked to SjD, whereas there is mixed data on past smoking. Smoking also seems to impact SjD outcomes, influencing comorbidities like hypertension or associated immune-mediated diseases, and, less clearly, extraglandular involvement, particularly pulmonary disease. Minor salivary gland biopsy findings indicate a lower frequency of positivity associated with smoking, with a potential dose-response relationship. However, smoking's uncertain effect on dryness symptoms complicates interpretation of data with reverse causation remaining a possibility. This review underscores the complexity of the smoking-SjD connection, raising questions about causality and potential protective effects on either SjD's development and/or classification criteria. Understanding these nuances may help unravel SjD pathogenesis and inform future therapeutic strategies.
