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Smokers With Systemic Sclerosis Risk Severe Digital Vascular Complications

Patients with systemic sclerosis (SSc) who smoke are three to four times more likely than are never-smokers to incur digital vascular complications, researchers in England have found.

This finding signals a need for more resources to support smoking cessation programs for these patients, underline investigators from the North Manchester General Hospital and ARC Epidemiology Unit, Manchester, and the Rheumatic Diseases Center, Hope Hospital, Salford.

With smoking a risk factor for vascular disease in the general population, and SSc patients at high risk for digital vascular complications, including amputation and gangrene, Dr Beverley J. Harrison and colleagues investigated the influence of smoking on digital ischemia in these patients.

One hundred and one participating SSc patients, 87 women and 24 men, were a median age of 53 years and had had SSc for a mean 13 years. Their smoking history was defined in terms of their current smoking status and total number of pack-years.

Digital ischemic events were classified as debridement, hospital admission for intravenous (IV) administration of vasodilators and digital amputation.

Logistic regression, adjusting for age, sex and disease duration, was used to examine the influence of smoking on these events and results were expressed as the odds ratio (OR) and 95% confidence interval (95% CI).

Twenty-one (21%) of the patients were current smokers, 37 (37%) were ex-smokers and 43 (43%) had never smoked.

Once age, sex and disease duration were accounted for, current smokers were found to be significantly more likely than never-smokers to have had debridement (OR 4.5, 95% CI 1.1-18.3) or admission for intravenous vasodilators (OR 3.8, 95% CI 1.1-12.9). Moreover, patients who smoked at higher intensity were more likely to require admission for IV vasodilators.
Arthritis & Rheumatism 2002;46:12:3312-3316. "Cigarette smoking as a significant risk factor for digital vascular disease in patients with systemic sclerosis"

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