Should People With Systemic Lupus Erythematosus (SLE) Avoid Smoking?

Why should persons with systemic lupus erythematosus (SLE) avoid smoking?

Aside from the usual health concerns related to smoking (including risks of cancer of the lung, throat and esophagus, emphysema, bronchitis, heart disease, skin disease, stomach ulcers, blood vessel disease), there are several unique reasons why patients with SLE should not smoke. These include:

1. The lungs can become diseased in persons with SLE. This can occur because of inflammation of the blood vessels supplying the lungs (vasculitis), hardening and increased pressure in the arteries to the lungs (pulmonary hypertension), scarring (fibrosis) of the lungs, and infections. All of these conditions can become much more serious when the lungs are further injured by cigarette smoke. Smoking also constricts the blood vessels that receive and deliver oxygen and nutrients to and from the lungs, which can further decrease the oxygen levels in the blood used by the entire body.

2. Over half of patients with SLE develop spasming of the tiny blood vessels in the extremities (Raynaud's phenomenon). This condition can worsen as a direct result of cigarette smoking. (It can also improve when smoking is discontinued.) While Raynaud's phenomenon is most often mild, it can become severe and permanently damage fingers, toes or other areas.

3. Recently, it was reported that smoking interferes with the benefits of hydroxychloroquine (Plaquenil), chloroquine (Atabrine), and quinacrine for the skin disease of patients with SLE. Journal of Rheumatology 1998;25:1716-1719.

Thank you for your question.