Effect of Cigarette Smoking on Behcet Disease Prognosis in a Prospective Cohort Study

Abstract

Smoking is a risk factor for many rheumatic diseases and a determining factor for poor prognosis in a number of rheumatic diseases. Previous studies have shown that the intensity and activity of Behcet's disease is higher in smokers than in non-smokers. But it is not known how the effect of smoking on disease prognosis and response to treatment. The present study aims to prospectively evaluate the effect of smoking on the prognosis of Behcet's disease. Materials and Methods: The medical records of the participants were reviewed and demographic characteristics, disease activity status, clinical manifestations and organ damage data were collected from all patients with Behçet's disease. Then the patients were followed up for one year. The severity of Behcet's disease was determined based on the organs involved. Patients with retinal vasculitis, posterior uveitis, pyoderma gangrenosum, cellulitis, gastrointestinal bleeding, intestinal perforation, deep vein thrombosis (DVT), vasculitis, and CNS involvement except headache were classified as severe disease. Patients with oral ulcer, genital ulcer, erythema nodosum, pseudofolliculitis, superficial phlebitis, arthralgia, arthritis, headache, epididymitis, frequent diarrhea and colicky abdominal pain were classified as mild disease. The method provided by the World Health Organization was also used in the definition of different states of smoking. Finally, the patients' quality of life was also evaluated using the World Health Organization's Quality of Life Questionnaire. Behçet's disease activity was measured by the Behçet's Disease Current Activity Form (BDCAF). At the beginning of the project and 12 months after the follow-up, disease severity, disease activity, response to treatment and quality of life were evaluated and finally these parameters were compared in smokers and non-smokers. Results: Comparison of disease activity status, clinical manifestations and data related to organ damage, severity of Behcet's disease and disease complications between two groups of smoking and non-smoking patients had no statistically significant difference (P˂0.05), people without eye complications in The group of smoking patients was significantly higher than the non-smoking group (P=0.044), and the severity of eye complications in the patients of the smoking group was significantly higher than that of the non-smoking group (P=0.004). In the first years ( second (p=0.014) and second (p=0.009) and third (p=0.003), the amount of damage in smoking patients was significantly higher than in non-smoking patients. Also, the number of people who faced a change in strategy in the third year in the group of smoking patients (27.8%-15 people) was significantly more than the change in treatment strategy in non-smoking patients (14.1%-10 people) (p=0.048).