Smoking and Lupus: A Double Whammy!
Patricia S. Leisy
LFA Online Health Educator
A reprint from the Lupus Foundation of America Lupus News, Volume 20, Number 3, Summer 2000

Lupus by itself can pack a powerful punch and may cause a variety of ill effects on one's health and well being. Most people with lupus ask, "Is there anything I can do to improve my health and chances for a long life? Is there any special diet or exercise? Anything I should avoid?" There are a number of replies to these questions and many have been the topic of previous articles in Lupus News. This article will focus on one of the most significant lifestyle choices to impact health: smoking.

Lupus plus smoking equals…

Any small benefit gleaned from cigarette smoking is far outweighed by tobacco's negative effects. The following list pairs what we know about lupus with the known effects of smoking. People with lupus are more susceptible to infections, with respiratory infections among the most common. Smoking cigarettes increases the risk of pneumococcal pneumonia and chronic bronchitis. Researchers report that passive smoking, or regular exposure to secondhand smoke, also raises the risk of having this type of pneumonia. New England Journal of Medicine 2000 Mar 9; 342(10):681-9 Smoking or hanging around others who do may increase your risk of pneumococcal pneumonia.

People with lupus on long-term moderate (11-40mg/day) to high (41-100mg/day) doses of prednisone have been found to develop heart disease (atherosclerosis) 20 to 30 years earlier than the general population. It's not uncommon for angina (heart muscle pain ) and even heart attacks to occur in lupus patients as young as 30 or 40 years of age. Smoking increases the risk of coronary artery disease. If you smoke and have lupus you greatly increase the risk of damaging your heart.

Lupus can affect the blood vessels and circulation in a variety of ways. Raynaud's disease is common in people with lupus and when active, results in poor circulation to the hands and feet. Lupus vasculitis can cause narrowing of blood vessels and reduced blood flow to tissues and organs. Antiphospholipid antibodies may increase the risk of serious blood clots and stroke. Smoking narrows blood vessels and worsens peripheral vascular disease (poor blood supply). Smoking contributes to blood vessel spasms and can magnify the effect of Raynaud's making a mild case worse, and could result in severe damage to fingers and toes. Smoking increases the risk of stroke.

Kidney disease in lupus can result in hypertension. A study at Stanford University of patients with lupus nephritis found that those who smoked progressed to end stage kidney disease far more quickly than did non-smokers (145 months vs. 273 months). Archives of Internal Medicine 1992 Oct; 152(10): 2082-8 Smoking contributes to elevated blood pressure which increases the risk of stroke and worsening kidney disease.

People with lupus can also develop diabetes and thereby be prone to poor wound healing. Smoking slows wound healing. Smoking increases the risk of heart attack in diabetics (insulin or non-insulin dependent).

Avascular necrosis of bone can develop in lupus and may require surgery. Smoking slows recovery from illness and surgery. Smoking slows bone healing.

Heartburn is found in 10 to fifty percent of people with lupus. Smoking has harmful effects on all parts of the digestive system, contributing to such common disorders as heartburn. National Institute of Diabetes and Digestive and Kidney Disease - .

Many of the medications used to alleviate symptoms of lupus are broken down by the liver. Lupus can affect the liver. Smoking affects the liver, too, by changing the way it metabolizes drugs and alcohol. In some cases, this may influence the dose of medication necessary to treat an illness.

Lupus can cause skin disease, which may be effectively treated with antimalarial medications. Smoking has been shown to interfere with the benefits of hydroxychloroquine (Plaquenil), chloroquine (Aralen), and quinacrine (Atabrine) for the skin disease of patients with SLE. Journal of Rheumatology 1998; 25:1716-1719 A study at the University of Minnesota of patients with discoid lupus erythematosus (DLE) found that smoking was more prevalent in people with DLE compared to those with other skin diseases and those in the general population. The researchers proposed that smoking may be a risk factor for development of DLE. Cutis 1999 Apr; 63(4):231-4) Studies conducted at Johns Hopkins University School of Medicine have found lupus skin disease is more active in smokers than non-smokers. The Lupus Book 2000; 187

Lupus can cause hair loss and other skin symptoms. Smoking has been associated with skin diseases and studies in mice indicate a link may exist between smoking and both hair loss and premature gray hair. Toxicology Letters 2000 Apr 3;114(1-3):117-123

Medications used in the treatment of lupus: prednisone, excessive thyroid hormones, anticonvulsants, antacids containing aluminum, and heparin increase the risk for fragile bones or osteoporosis. Smoking magnifies the risk for osteoporosis. In addition, over the years research has consistently shown that cigarette smoking causes skin wrinkling that could make smokers appear prematurely old. Make a positive impact on your lupus! It is clear that smoking complicates and accelerates the ill effects of lupus. We also know that most of the negative effects are reversible when smoking stops. In the Harvard Nurse's Health Study the authors concluded there are immediate benefits to discontinuing smoking and eventually the risk of coronary heart disease returns to the level of non-smokers. Arch Intern Med 1994 Jan 24; 154(2): 169-75

More than any other lifestyle choice you make, quitting cigarettes will have the greatest positive impact on your lupus. It's never too late to quit If you've been smoking a long time and think there is no point in quitting, think again! According to the National Heart, Lung, and Blood Institute's : "You may be surprised to learn that older smokers are actually more likely to succeed at quitting smoking. Older smokers who stop want to avoid further health problems, take control of their life, get rid of the smell of cigarettes, and save money. Stopping smoking does help people who have suffered a heart attack. In fact, their chances of having another attack are smaller. In some cases, ex-smokers can cut their risk of another heart attack by half or more.

Smokers, especially those over 50 years old, are much more likely to get tired, feel short of breath, and cough more often. These symptoms can signal the start of bronchitis or emphysema, both of which are suffered more often by older smokers. Stopping smoking will help reduce these symptoms. Older smokers who try to quit are more likely to stay off cigarettes. Most smokers would prefer to quit. In fact, in a recent study, 65 percent of older smokers said that they would like to stop. What keeps them from quitting? They are afraid of being irritable, nervous, and tense. Others are concerned about cravings for cigarettes. Most don't want to gain weight. Many think it's too late to quit--that quitting after so many years of smoking will not help. But this is not true." There's no other lifestyle choice you can make that will have more of an impact on your health than the decision not to smoke.

For tips on quitting see the Center for Disease Control's (CDC) web site: www.cdc.gov/