Özlem PEHLİVAN, Yasemin YALÇINKAYA, Bahar ARTIM ESEN, Nihat HÜSEYİNSİNOĞLU, Ahmet GÜL, Murat İNANÇ, Lale ÖÇAL

TÜMÖR NEKROZİS FAKTÖR İNHİBİTÖRÜ TEDAVİSİ ALAN AKSİYAL SPONDİLOARTRİTLİ HASTALARDA SİGARANIN ETKİLERİ

Amaç: Bu çalışma tümör nekrozis faktör alfa inhibitörü (TNFi) alan aksiyal spondiloartrit (axSpA) hastalarında sigaranın etkisini değerlendirme amacıyla yapıldı.Gereç ve Yöntem: Çalışmamıza Romatoloji polikliniğinde axSpA tanısıyla tümör nekroz faktör alfa (TNFα) inhibitörü tedavisi alan 211 hasta alındı. Hastalar retrospektif, kesitsel olarak değerlendirildi ve sigara içme yoğunluğuna (paket-yıl) göre gruplandırıldı. Sigarayı >20 paket yıl üzerinde içenler ağır içiçi olarak tanımlandı. Gruplar fizik muayene ölçümleri, laboratuar ve hastalık değerlendirme indeksleri (Bath Ankylosing Spondylitis Metrology Index (BASMI), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI) ve Ankylosing Spondylitis Quality of Life (ASQoL) ve Beck Depression Inventory (BDI)) ile karşılaştırıldı. Verilerin analizinde Mann-Whitney U ve Spearman korelasyon analizi testleri kullanıldı.Bulgular: Sigara içen (n=121) ve içmeyen (n=90) grup karşılaştırıldığında BASMI sigara içmeyen grupta düşük bulunmuştur (p=0,04). Sigara içme yoğunluğu ile yapılan korelasyon analizinde BDI (r=0,323, p<0,001), BASDAI (r=0,257, p=0,005) ve BASMI bileşenleri (lomber lateral fleksiyon (LLF) (r=- 0,303, p=0,001) bulunmuştur. Multiple lineer regresyon analizinde sigara paket-yılı ile BASMI [regresyon katsayısı (B)=0,067, standart hata (SE)=0,22, %95CI=0,02, 0,10; p=0,003], BASFI’nin başlangıç (B=tedavi öncesi) ve son değeri (L=tedavi sonrası) arasındakifarkı [B=-0,063, SE=0,02, %95CI=-0,10, -0,20; p=0,003], BASDAI [B=-0.047, SE=0,02, %95CI=-0,08, -0,007; p=0,026] ve ASQoL [B=-0,125, SE=0,04, %95CI=0,04, -0,20; p=0,003] arasında ilişki saptandı. Ağır sigara içicilerinde LLFL (p=0,01),CRL (p=0,04), TWDL (p=0,001), BASFIL (p=0,035) ve BASMIL (p=0,001)’de anlamlı kötüleşme bulundu. Nonradyografik-axSpA grubunda ağır içicilerde AS grubuna göre BASDAIB-L (p=0,042), BASFIL (p=0,002), BASFIB-L (p=0,07) ve BASMI (p=0,03) değerlerinde anlamlı farklılıklar saptandı.Sonuç: Çalışmamız sigara kullanımının özellikle sigara içme yo- ğunluğunun axSpA’nın her döneminde olumsuz etkisi olduğu göstermiştir. Sigara içme yoğunluğu, TNFi’ye verilen yanıtın azal- masıyla ilişkili olabilir.

Anahtar Kelimeler:

Aksiyal spondiloartrit, ankilozan spondilit, non-radyografik aksiyal spondiloartrit, tümör nekrozis faktör inhi- bitörü tedavisi, sigara

EFFECTS OF SMOKING IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS RECEIVING TUMOR NECROSIS FACTOR INHIBITORS THERAPY

Objective: The aim of this study was to examine the impact of smoking on axial spondyloarthritis (axSpA) patients taking tumor necrosis factor inhibitors (TNFi).Material and Method: Our study consisted of 211 patients who were diagnosed with axSpA and received TNFi treatment in the rheumatology outpatient clinic. The patients were evaluated retrospectively, cross-sectionally and grouped by intensity of smoking (pack-years). Those who smoked>20 pack-years were defined as heavy smokers. Groups were compared in terms of physical examination, laboratory values and disease evaluation indexes (Bath Ankylosing Spondylitis Metrology Index (BASMI), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Ankylos- ing Spondylitis Quality of Life (ASQoL) and Beck Depression In- ventory (BDI) scores. Mann-Whitney U and Spearman correlation analysis tests were used for data analysisResults: Comparison of the smoker (n=121) and non-smoker groups (n=90) revealed BASMI was lower in the non-smoker group (p=0.04). Smoking intensity correlated with BDI (r=0.323, p<0.001), BASDAI (r=0.257, p=0.005), BASMI components (lomber lateral flexion (LLF) (r=-0.303, p=0.001), cervical rotation (CR) (r=-0.232, p=0.012), and tragus wall distance (TWD) (r=0.27, p=0.003)). Multivariate analysis revealed an association between the pack-years of smoking and the BASMI [regression coefficient (B)=0.067, standard error (SE)=0.22, 95%CI=0.02, 0.10; p=0.003], baseline (B=pretreatment)-last value (L.=posttreatment) difference of BASFI [B=-0.063, SE=0.02, 95%CI=-0.10, -0.20; p=0.003], of BASDAI [B=-0.047, SE=0.02, 95%CI=-0.08, -0.007; p=0.026], ASQoL [B=-0.125, SE=0.04, 95%CI=0.04, -0.20; p=0.003]. In heavy smokers, significant worsening was found in LLFL (p=0.01), CRL (p=0.04), TWDL (p=0.001), BASFIL (p=0.035) and BASMIL (p=0.001). Significant differences were found in the baseline (B) and last (L) BASDAI (p=0.042), BASFIL (p=0.002), BASFIB-L (p=0.07) and BASMI (p=0.03) values in the nonradiograpic-axSpA group in heavy smokers, compared to the AS group.Conclusion: Our study showed that smoking, especially heavy smoking, has a negative effect in every phase of axSpA. Smok- ing intensity may correlate with reduced response to TNFi.Keywords: Axial spondyloarthritis, ankylosing spondylitis, non-radiographic axial spondyloarthiris, tumor necrosis factor inhibitor therapy, smoking

Keywords:

Axial spondyloarthritis, ankylosing spondylitis, non-radiographic axial spondyloarthiris, tumor necrosis factor inhibitor therapy, smoking,

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