{
  "abstract": "Introduction Systemic sclerosis (SSc) is a rare multisystem autoimmune disease, characterized by progressive fibrosis and vascular damage. Although tobacco smoking has been linked to the development of autoimmune rheumatic diseases, namely rheumatoid arthritis, its specific influence on the immune system and some manifestations of SSc remain uncertain. The present study aimed to evaluate the impact of active, past, and passive smoking on the clinical manifestations of SSc, immunological profile, and physical disability and patient perception of disease burden, assessed through the Scleroderma Health Assessment Questionnaire (SHAQ).Material and Methods A retrospective monocentric study was conducted on patients registered in the national database Reuma.pt in August 2025. Data on smoking status was collected. Patients were initially categorized as ‘ever-smokers,’ ‘never-smokers,’ and ‘passive smokers.’ The ‘ever-smoker’ group was subsequently subdivided into ‘current smokers’ and ‘former smokers.’ Baseline characteristics of SSc patients were summarized using descriptive analysis. Clinical variables included telangiectasias, Raynaud’s phenomenon, skin thickening, digital ulcers, and esophageal, pulmonary, cardiac, and renal involvement. Immunological variables comprised anti-centromere, Scl-70, and RNA polymerase III (anti-RNAP III) antibodies. Modified Rodnan skin score and SHAQ scores were also analyzed. For comparisons between groups, both parametric and non-parametric statistical tests were applied, as appropriate. Statistical significance was set at p<0.05.Results The study population consisted of 166 patients: 158 women (95.2%), with a mean age of 62.2±12.2 years and mean disease duration of 11.2±8.4 years. 66.9% of patients had limited cutaneous SSc. The ‘ever-smoker’ group accounted for 23.5% of patients (16.3% former smokers and 7.2% current smokers). Although women were less frequently active smokers (5.7% vs. 37.5%), they were more exposed to passive smoke (12.6% vs. 0.6%) then men. No significant associations were found between smoking (active or passive), the immunological profile and arthritis. Passive smoking was significantly associated with multiorgan involvement, including gastric (31.25% vs.4,5%, p = 0.004), cardiac (10.5% vs.1.4%, p = 0.026), renal (5% vs.0%, p = 0.01), and intestinal (10.5% vs.0,7%, p = 0.020). Tobacco exposure was linked to worse outcomes in the SHAQ Raynaud’s and Ulcer sub-scores, although no significant differences were observed in the SHAQ Global.Conclusions This study highlights a potentially underestimated role of tobacco exposure in the pathogenesis of SSc. These findings emphasize the importance of further research, smoking cessation, and prevention of passive exposure as essential elements in the management of SSc.",
  "authors": [
    {
      "affiliations": [
        "Rheumatology Department, ULS São João, Porto, Portugal, Porto, Portugal"
      ],
      "name": "Sara Amaro Lopes"
    },
    {
      "affiliations": [
        "Rheumatology Department, ULS São João, Porto, Portugal, Porto, Portugal"
      ],
      "name": "Mariana Diz-Lopes"
    },
    {
      "affiliations": [
        "Rheumatology Department, ULS São João, Porto, Portugal, Porto, Portugal"
      ],
      "name": "Carlos Marques-Gomes"
    },
    {
      "affiliations": [
        "Rheumatology Department, Hospital do Divino Espírito Santo, Ponta Delgada, Portugal, Ponta Delgada, Portugal"
      ],
      "name": "Marina Oliveira"
    },
    {
      "affiliations": [
        "Rheumatology Department, ULS São João, Porto, Portugal, Porto, Portugal"
      ],
      "name": "Bárbara Fernandes Esteves"
    },
    {
      "affiliations": [
        "Rheumatology Department, ULS São João, Porto, Portugal, Porto, Portugal"
      ],
      "name": "Miguel Correia Natal"
    },
    {
      "affiliations": [
        "Rheumatology Department, ULS São João, Porto, Portugal, Porto, Portugal"
      ],
      "name": "Ana da Rocha Sá"
    },
    {
      "affiliations": [
        "Rheumatology Department, ULS São João, Porto, Portugal, Porto, Portugal"
      ],
      "name": "Bruno Miguel Fernandes"
    },
    {
      "affiliations": [
        "Rheumatology Department, ULS São João, Porto, Portugal, Porto, Portugal"
      ],
      "name": "Georgina Terroso"
    },
    {
      "affiliations": [
        "Rheumatology Department, ULS São João, Porto, Portugal, Porto, Portugal"
      ],
      "name": "Lúcia Costa"
    },
    {
      "affiliations": [
        "Rheumatology Department, ULS São João, Porto, Portugal, Porto, Portugal"
      ],
      "name": "Raquel Miriam Ferreira"
    }
  ],
  "title": "P.004 Impact of active and passive exposure to tobacco on systemic sclerosis manifestations, disability and quality of life- data from a tertiary centre",
  "uid": "8a1d3b8a-7813-5e88-800f-8cec3eabcd47"
}