Lower frequency of focal lip sialadenitis (focus score) in smoking patients. Can tobacco diminish the salivary gland involvement as judged by histological examination and anti-SSA/Ro and anti-SSB/La antibodies in Sjogren's syndrome?

Objectives-Prospectively collected computer database information was previo ysly assessed on a cohort of 300 patients who fulfilled the Copenhagen clas sification criteria for primary Sjogren's syndrome. Analysis of the clinica l data showed that patients who smoked had a decreased lower lip salivary g land focus score (p<0.05). The aim of this original report is to describe t he tobacco habits in patients with primary Sjogren's syndrome or stomatitis sicca only and to determine if there is a correlation between smoking habi ts and focus score in lower lip biopsies as well as ciculating autoantibodi es and IgG. Methods-All living patients with primary Sjogren's syndrome or stomatitis s icca only, who were still in contact with the Sjogren's Syndrome Research C entre were asked to fill in a detailed questionnaire concerning present and past smoking habits, which was compared with smoking habits in a sex and a ge matched control group (n=3700) from the general population. In addition, the patients previous lower lip biopsies were blindly re-evaluated and div ided by the presence of focus score (focus score = number of lymphocyte foc i per 4 mm(2) glandular tissue) into those being normal (focus score less t han or equal to 1) or abnormal (focus score > 1). Furthermore the cohort wa s divided into three groups; 10-45, 46-60 and greater than or equal to 61 y ears of age. Finally the focus score was related to the smoking habits. Ser oimmunological Abstract Objectives-Prospectively collected computer databas e information was previously assessed on a cohort of 300 patients SSB/La an tibodies; IgM-RF samples were analysed routinely. Results-The questionnaire was answered by 98% (n=355) of the cohort and the percentage of current smokers, former smokers and historical non-smokers a t the time of lower lip biopsy was not statistically different from that of the control group. Cigarette smoking at the time of lower lip biopsy is as sociated with lower risk of abnormal focus score (p<0.001; odds ratio 0.29, 95%CI 0.16 to 0.50). The odds ratio for having focal sialadenitis (focus s core > 1) compared with having a non-focal sialadenitis or normal biopsy (f ocus score less than or equal to 1) was decreased in all three age groups ( 10-45: odds ratio 0.27, 95%CI 0.11 to 0.71; 46-60: odds ratio 0.22, 95%CI 0 .08 to 0.59; and greater than or equal to 61: odds ratio 0.36, 95%CI 0.10 t o 1.43) although there was only statistical significance in the two younger age groups. Moreover, among current smokers at the time of the lower lip b iopsy there was a decreasing odds ratio for an abnormal lip focus score wit h increasing number of cigarettes smoked per week (p trend 0.00). In the gr oup of former smokers, which included patients that had stopped smoking up to 30 years ago, the results were in between those of the smokers and the h istorical non-smokers (odds ratio 0.57, 95%CI 0.34 to 0.97, compared with n ever smokers). Present or past smoking did not correlate with the function of the salivary glands as judged by unstimulated whole sialometry, stimulat ed whole sialometry or salivary gland scintigraphy. Among former smokers, t he median time lapse between the first symptom of primary Sjogren's syndrom e and the performance of the lower lip biopsy was approximately half as lon g as the median time lapse between smoking cessation and biopsy (8 versus 1 5 years). Hence, symptoms of Sjogren's syndrome are unlikely to have had a significant influence on smoking habits at the time of the biopsy. Among th e seroimmunological results only anti-SSA/Ro and anti-SSB/La antibodies rea ched statistical significance in a manner similar to the way smoking influe nced the focus score in lower lip biopsies. On the other hand the level of significance was consistently more pronounced for the influence of smoking on the focus score than for the influence on anti-SSA/Ro and anti-SSB/La au toantibodies. Conclusion-This is believed to be the first report showing th at cigarette smoking is negatively associated with focal sialadenitis-focus score >1-in lower lip biopsy in patients with primary Sjogren's syndrome. Furthermore, tobacco seems to decrease the focus score in a dose dependent manner. Smoking may also negatively influence the presence of anti-SSA/Ro a nd/or anti-SSB/La antibodies in circulating blood. Thus, smoking habits of patients might invalidate the use of both lower lip salivary gland focus sc ore and of anti-SSA/anti-SSB antibodies. It is suggested that the simultane ous performance of other objective tests is required to avoid misdiagnosis of oral involvement in smoking and former smoking patients. Therefore, clas sification criteria for Sjogren's syndrome that more or less rely on an abn ormal focus score and/or presence of anti-SSA/anti-SSB antibodies should be used with great caution.