{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T23:59:25Z","timestamp":1790553565835,"version":"4.1.0"},"reference-count":27,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,1,10]],"date-time":"2023-01-10T00:00:00Z","timestamp":1673308800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background and aims: The effect of smoking on disease activity and quality of life (QoL) in spondyloarthritis (SpA) is far from clear. We aimed to evaluate the relationship between smoking and these outcomes in patients with axial SpA (axSpA) and psoriatic arthritis (PsA). Patients and methods: This cross-sectional observational multicenter study included 242 patients with axSpA and 90 with PsA. The association between conventional cardiovascular risk factors and disease activity as well as QoL, in both SpA phenotypes was evaluated. For this, univariate and multivariate regression analyses were performed, as well as confirmatory meta-analyses. Results: Regardless of age, sex, or disease duration, patients with axSpA showed significantly less association with obesity (OR 0.50 (0.26\u20130.96), p = 0.03) and hypertension (OR 0.33 (0.18\u20130.62), p = 0.0005). However, axSpA was significantly associated with smoking (OR 2.62 (1.36\u20135.04), p = 0.004). Patients with axSpA were more likely to be in a category of high disease activity compared with PsA (OR 2.86, p = 0.0006). Regardless of sex, age, disease duration, and education level, smoking was significantly associated with higher disease activity in axSpA (OR 1.88, p = 0.027). A fixed-effects model meta-analysis (OR 1.70, p = 0.038) confirmed the association between tobacco and disease activity. No relationship was found between smoking (or other cardiometabolic risk factors) and structural damage or worse QoL in either disease. Conclusions: Although the cardiometabolic risk profile is clearly different between both SpA phenotypes, the only clear link between these factors and increased disease activity was observed between smoking and axSpA. Our findings need further confirmation.<\/jats:p>","DOI":"10.3390\/jcm12020551","type":"journal-article","created":{"date-parts":[[2023,1,10]],"date-time":"2023-01-10T01:57:48Z","timestamp":1673315868000},"page":"551","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Differentiated Effect of Smoking on Disease Activity and Quality of Life among Different Spondyloarthritis Phenotypes"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5274-320X","authenticated-orcid":false,"given":"Sara","family":"Alonso-Castro","sequence":"first","affiliation":[{"name":"Rheumatology Division, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Garc\u00eda-Valle","sequence":"additional","affiliation":[{"name":"Rheumatology Division, Complejo Hospitalario de Palencia, 34004 Palencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1413-909X","authenticated-orcid":false,"given":"Isla","family":"Morante-Bolado","sequence":"additional","affiliation":[{"name":"Rheumatology Division, Hospital de Sierrallana, 39300 Torrelavega, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ignacio","family":"Bra\u00f1a","sequence":"additional","affiliation":[{"name":"Rheumatology Division, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Estefan\u00eda","family":"Pardo","sequence":"additional","affiliation":[{"name":"Rheumatology Division, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8418-7145","authenticated-orcid":false,"given":"Rub\u00e9n","family":"Queiro","sequence":"additional","affiliation":[{"name":"Rheumatology Division, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain"},{"name":"ISPA Translational Immunology Division, 33011 Oviedo, Spain"},{"name":"School of Medicine, Oviedo University, 33011 Oviedo, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2127","DOI":"10.1016\/S0140-6736(11)60071-8","article-title":"Spondyloarthritis","volume":"377","author":"Dougados","year":"2011","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1080\/1744666X.2018.1468252","article-title":"Quality of life in psoriatic arthritis","volume":"14","author":"Gudu","year":"2018","journal-title":"Expert Rev. Clin. Immunol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1007\/s11926-019-0819-8","article-title":"The European Map of Axial Spondyloarthritis: Capturing the Patient Perspective\u2014An Analysis of 2846 Patients Across 13 Countries","volume":"21","author":"Poddubnyy","year":"2019","journal-title":"Curr. Rheumatol. Rep."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1097\/BOR.0000000000000588","article-title":"Measuring outcomes in ankylosing spondylitis: Pearls and pitfalls","volume":"31","author":"Magrey","year":"2019","journal-title":"Curr. Opin. Rheumatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1606","DOI":"10.1002\/acr.23172","article-title":"Determinants of Patient-Physician Discordance in Global Assessment in Psoriatic Arthritis: A Multicenter European Study","volume":"69","author":"Desthieux","year":"2017","journal-title":"Arthritis Care Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1016\/j.semarthrit.2017.05.010","article-title":"The psychosocial burden of psoriatic arthritis","volume":"47","author":"Husni","year":"2017","journal-title":"Semin. Arthritis Rheum."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1016\/j.berh.2019.01.002","article-title":"Cardiovascular morbidity and mortality in ankylosing spondylitis and psoriatic arthritis","volume":"32","author":"Liew","year":"2018","journal-title":"Best Pract. Res. Clin. Rheumatol."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Kamata, M., and Tada, Y. (2020). Efficacy and Safety of Biologics for Psoriasis and Psoriatic Arthritis and Their Impact on Comorbidities: A Literature Review. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21051690"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"62","DOI":"10.3389\/fmed.2018.00062","article-title":"Comorbidities in Spondyloarthritis","volume":"5","author":"Molto","year":"2018","journal-title":"Front. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s10067-018-4332-7","article-title":"Role of comorbidities in spondyloarthritis including psoriatic arthritis","volume":"38","author":"Scriffignano","year":"2019","journal-title":"Clin. Rheumatol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1472","DOI":"10.1093\/rheumatology\/keaa093","article-title":"Smoking in spondyloarthritis: Unravelling the complexities","volume":"59","author":"Zhao","year":"2020","journal-title":"Rheumatology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1136\/annrheumdis-2013-205133","article-title":"Impaired response to treatment with tumour necrosis factor \u03b1 inhibitors in smokers with axial spondyloarthritis","volume":"75","author":"Ciurea","year":"2016","journal-title":"Ann. Rheum. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1483","DOI":"10.3899\/jrheum.200025","article-title":"Performance of the ASAS Health Index for the Evaluation of Spondyloarthritis in Daily Practice","volume":"47","author":"Pardo","year":"2020","journal-title":"J. Rheumatol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1465","DOI":"10.1093\/rheumatology\/keaa626","article-title":"Construct validity of the ASAS health index in psoriatic arthritis: A cross-sectional analysis","volume":"60","author":"Morante","year":"2021","journal-title":"Rheumatology"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"36","DOI":"10.3899\/jrheum.201362","article-title":"Construct Validity of the Routine Assessment of Patient Index Data 3 (RAPID3) in the Evaluation of Axial Spondyloarthritis","volume":"49","author":"Llano","year":"2022","journal-title":"J. Rheumatol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"8","DOI":"10.3899\/jrheum.200586","article-title":"The ASAS Health Index: A New Era for Health Impact Assessment in Spondyloar-thritis","volume":"49","author":"Alonso","year":"2022","journal-title":"J. Rheumatol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1012","DOI":"10.1136\/annrheumdis-2014-205207","article-title":"A patient-derived and patient-reported outcome measure for assessing psoriatic arthritis: Elaboration and preliminary validation of the Psoriatic Arthritis Impact of Disease (PsAID) questionnaire, a 13-country EULAR initiative","volume":"73","author":"Gossec","year":"2014","journal-title":"Ann. Rheum. Dis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1016\/j.rdc.2009.10.017","article-title":"A Multi-dimensional Health Assessment Questionnaire (MDHAQ) and routine as-sessment of patient index data (RAPID3) scores are informative in patients with all rheumatic diseases","volume":"35","author":"Pincus","year":"2009","journal-title":"Rheum. Dis. Clin. N. Am."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"93","DOI":"10.5993\/AJHB.32.1.9","article-title":"Smoking and physical activity: A systematic review","volume":"32","author":"Kaczynski","year":"2008","journal-title":"Am. J. Health Behav."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e000153","DOI":"10.1136\/rmdopen-2015-000153","article-title":"Lifestyle factors may modify the effect of disease activity on radiographic progression in patients with ankylosing spondylitis: A longitudinal analysis","volume":"1","author":"Ramiro","year":"2015","journal-title":"RMD Open"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1007\/s40266-019-00724-2","article-title":"Analysis by Age Group of Disease Outcomes in Patients with Psoriatic Arthritis: A Cross-Sectional Multicentre Study","volume":"37","author":"Queiro","year":"2020","journal-title":"Drugs Aging"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1007\/s40744-017-0066-2","article-title":"Improving the management of psoriatic arthritis and axial spondy-loarthritis: Roundtable discussions with healthcare professionals and patients","volume":"4","author":"Hillmann","year":"2017","journal-title":"Rheumatol. Ther."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1186\/s13075-018-1626-8","article-title":"Widespread pain in axial spondyloarthritis: Clinical importance and gender differences","volume":"20","author":"Swinnen","year":"2018","journal-title":"Arthritis Res. Ther."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1007\/s10067-018-4004-7","article-title":"Impact of cardiovascular risk factors on the achievement of therapeutic goals in psoriatic arthritis: Is there any association?","volume":"37","author":"Queiro","year":"2018","journal-title":"Clin. Rheumatol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"679009","DOI":"10.3389\/fmed.2021.679009","article-title":"Multicenter Study of Secukinumab Survival and Safety in Spondyloarthritis and Psoriatic Arthritis: SEcukinumab in Cantabria and ASTURias Study","volume":"8","author":"Alonso","year":"2021","journal-title":"Front. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/j.reumae.2017.01.009","article-title":"Effect of Weight Loss on Activity in Psoriatic Arthritis: A Systematic Review","volume":"14","author":"Zarco","year":"2018","journal-title":"Reumatol. Cl\u00edn. (Engl. Ed.)"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1007\/s00296-016-3590-4","article-title":"Increasing smoking intensity is associated with increased disease activity in axial spondyloarthritis","volume":"37","author":"Zhao","year":"2017","journal-title":"Rheumatol. Int."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/2\/551\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:05:06Z","timestamp":1760119506000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/2\/551"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,10]]},"references-count":27,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,1]]}},"alternative-id":["jcm12020551"],"URL":"https:\/\/doi.org\/10.3390\/jcm12020551","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,10]]}}}