Tobacco smoking is an independent factor associated with retinal damage in systemic lupus erythematosus: a cross-sectional and retrospective study

  • Iñigo Rúa-FigueroaEmail author
  • Celia Erausquin
  • Celia Rua-Figueroa
  • Jesús González-Martín
  • Antonio Naranjo
  • Soledad Ojeda
  • Félix Francisco
  • Juan C. Quevedo
  • Laura Cáceres
  • Ruben López
  • Martin Greco
  • Irene Altabás-González
  • Yanira Pérez
  • Francisco Rubiño
  • Carlos Rodríguez-Lozano
Observational Research


To analyze the influence of tobacco smoking on systemic lupus erythematosus (SLE) clinical features and damage. Cross-sectional and retrospective, case–control study comparing SLE patients with and without tobacco exposure. Cumulative clinical data and comorbidities were collected, and severity (Katz index) and damage (SLICC/ACR damage index) (SDI) indices were calculated. Pack-years (PY) was used to estimate lifetime tobacco exposure. A logistic regression was carried out to explore the impact of tobacco use on retinal damage. 216 patients were included. The mean age was 49 years (± 12.7), 93% were females, and median disease duration was 17 years [interquartile range (IQR):9–25]. Fifty-three percent of patients were smokers at some point. The median PY was 13 (IQR: 6–20.5). Only 54.8% of active smokers recalled having been informed of the negative effects of smoking, versus 83.3% of never smokers (< 0.001). In a bivariant analysis, an association between tobacco use at any time and discoid lupus [OR: 3.5(95%CI 1.5–8.9); p = 0.002] photosensitivity [OR: 2.06(95%CI 1.16–3.7); p = 0.01] and peripheral arteriopathy (p = 0.007) was found. Considering SDI item by item, a significant association with retinal damage, adjusted for age [OR: 1.03(95%CI 1–1.07); p = 0.04], was found. Using PYs, an association was found with discoid lupus (p = 0.01), photosensitivity (p = 0.03) and peripheral arteriopathy (p = 0.01), global SDI > 0 (p = 0.002) and retinal damage (p = 0.02). In a multivariate analysis exploring factors associated with retinal damage, any previous smoking history and SDI remained associated with retinal damage. Tobacco smoking is associated with cutaneous manifestations and damage and is an independent predictor of retinal damage in SLE patients.


Lupus Tobacco Retinal 



We would like to thank the Spanish Society of Rheumatology Research Unit for its assistance in the English language manuscript review. There was no financial support for this original.

Compliance with ethical standards

Conflicts of interest:

All of the authors declare no conflicts of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Iñigo Rúa-Figueroa
    • 1
    Email author
  • Celia Erausquin
    • 1
  • Celia Rua-Figueroa
    • 2
  • Jesús González-Martín
    • 3
  • Antonio Naranjo
    • 1
  • Soledad Ojeda
    • 1
  • Félix Francisco
    • 1
  • Juan C. Quevedo
    • 1
  • Laura Cáceres
    • 1
  • Ruben López
    • 1
  • Martin Greco
    • 1
  • Irene Altabás-González
    • 1
  • Yanira Pérez
    • 1
  • Francisco Rubiño
    • 1
  • Carlos Rodríguez-Lozano
    • 1
  1. 1.Rheumatology ServiceHospital Universitario de Gran Canaria Doctor NegrinLas PalmasSpain
  2. 2.Medical SchoolUniversity of Las Palmas de Gran CanariaLas PalmasSpain
  3. 3.Research UnitHospital de Gran Canaria Doctor NegrinLas PalmasSpain

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