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Furthermore, we explored whether there was an effect modification between these two factors. We included adult SLE patients from the Link\u00f6ping University Hospital (<jats:italic>n<\/jats:italic>\u2009=\u2009325) in the present cross-sectional analysis. We further included population-based controls and performed cardinality matching to balance age and sex distributions with cases (<jats:italic>n<\/jats:italic>\u2009=\u2009224). HRQoL was assessed with the EQ-5D index score; pain, fatigue, and overall SLE-related health state with visual analogue scales (VAS; 0 [best] to 100 [worst]); and functional impairment with the HAQ-DI. Unacceptable outcomes were defined as VAS scores corresponding to the 90th percentile derived from the matched controls. SLE patients reported worse scores than controls in all measures, and approximately 30% experienced unacceptable outcomes. When compared with normal-weight, obese SLE patients reported lower HRQoL, and greater functional impairment and risk of unacceptable pain (OR: 3.2; 95% CI 1.6\u20136.7) and fatigue (OR: 2.1; 95% CI 1.0\u20134.3). Similarly, the current smokers reported higher levels of functional impairment and a greater risk of unacceptable pain (OR: 3.8; 95% CI 1.8\u20138.2) and fatigue (OR: 2.8; 95% CI 1.3\u20135.9) than never smokers. The associations were independent of age, sex, disease duration, disease activity, and organ damage. There was no evidence of a synergistic effect between increased BMI and smoking on any outcome. In summary,\u00a0obesity\u00a0and smoking are risk factors for unacceptable patient-reported outcomes in SLE, regardless of clinical activity.<\/jats:p>","DOI":"10.1007\/s00296-024-05546-z","type":"journal-article","created":{"date-parts":[[2024,3,7]],"date-time":"2024-03-07T06:01:52Z","timestamp":1709791312000},"page":"851-861","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Obesity and tobacco smoking are independently associated with poor patient-reported outcomes in SLE: a cross-sectional study"],"prefix":"10.1007","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9618-1755","authenticated-orcid":false,"given":"Alvaro","family":"Gomez","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4875-5395","authenticated-orcid":false,"given":"Ioannis","family":"Parodis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0900-2048","authenticated-orcid":false,"given":"Christopher","family":"Sj\u00f6wall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,3,7]]},"reference":[{"issue":"3","key":"5546_CR1","doi-asserted-by":"publisher","first-page":"501","DOI":"10.1177\/0961203317722412","volume":"27","author":"V Golder","year":"2018","unstructured":"Golder V, Ooi JJY, Antony AS et al (2018) Discordance of patient and physician health status concerns in systemic lupus erythematosus. 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CS has received speaker\u2019s honoraria from AstraZeneca, Novartis and Bristol-Myers Squibb. AG declares that he has no conflicts of interest related to this work. The funders had no role in the design of the study, the analyses or interpretation of data, or the writing of the manuscript.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The study was conducted in compliance with the ethical principles of the Declaration of Helsinki. Written informed consent was obtained from all study participants. Ethical permission for the present investigation was obtained from the Regional Ethics Board in Link\u00f6ping (reference: M75-08; date of approval: 2008-05-22).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical standards"}},{"value":"Data from the current work have been previously presented at one scientific meeting [].","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Congress abstract publication"}}]}}