Cigarette smoking and progression of multiple sclerosis

Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA.
Brain (Impact Factor: 9.2). 07/2005; 128(Pt 6):1461-5. DOI: 10.1093/brain/awh471
Source: PubMed


An increased risk of multiple sclerosis among smokers has been found in several prospective epidemiological studies. The association between smoking and progression of multiple sclerosis has not been examined. We identified patients who had a first multiple sclerosis diagnosis recorded in the General Practice Research Database (GPRD) between January 1993 and December 2000. Their diagnosis and date of first symptoms were confirmed through examination of medical records. Smoking status was obtained from the computer records. To assess the association between smoking and risk of multiple sclerosis, we conducted a case-control study nested in the GPRD. Up to 10 controls per case were randomly selected, matched on age, sex, practice, date of joining the practice and availability of smoking data. To assess the association between smoking and progression of multiple sclerosis, we conducted a cohort study of multiple sclerosis cases with a relapsing-remitting onset. Our nested case-control study included 201 cases of multiple sclerosis and 1913 controls. The odds ratio [95% confidence interval (CI)] of multiple sclerosis was 1.3 (1.0-1.7) for ever smokers compared with never smokers. Our cohort study included 179 cases with a mean (median) length of follow-up of 5.3 (5.3) years. The hazard ratio of secondary progression was 3.6 (95% CI 1.3-9.9) for ever smokers compared with never smokers. These results support the hypothesis that cigarette smoking is associated with an increased risk of multiple sclerosis, and suggest that smoking may be a risk factor for transforming a relapsing-remitting clinical course into a secondary progressive course.

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    • "Genetic polymorphisms have been associated with MS risk and/or pathogenesis (Beecham et al., 2013; Sawcer et al., 2011). However, environmental factors such as infections (Ascherio et al., 2001; Correale and Farez, 2007; Correale et al., 2006), sodium intake (Farez et al., 2014), smoking (Herná n et al., 2005), and vitamin D levels (Ascherio et al., 2014) are also known to affect MS development and course. Lower levels of vitamin D, for example, are associated with higher relapse rates (Runia et al., 2012; Simpson et al., 2010). "
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    ABSTRACT: Seasonal changes in disease activity have been observed in multiple sclerosis, an autoimmune disorder that affects the CNS. These epidemiological observations suggest that environmental factors influence the disease course. Here, we report that melatonin levels, whose production is modulated by seasonal variations in night length, negatively correlate with multiple sclerosis activity in humans. Treatment with melatonin ameliorates disease in an experimental model of multiple sclerosis and directly interferes with the differentiation of human and mouse T cells. Melatonin induces the expression of the repressor transcription factor Nfil3, blocking the differentiation of pathogenic Th17 cells and boosts the generation of protective Tr1 cells via Erk1/2 and the transactivation of the IL-10 promoter by ROR-α. These results suggest that melatonin is another example of how environmental-driven cues can impact T cell differentiation and have implications for autoimmune disorders such as multiple sclerosis.
    Cell 09/2015; 162(6):1338-1352. DOI:10.1016/j.cell.2015.08.025 · 32.24 Impact Factor
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    • "d explain gender differences in autoimmune disease . Smoking is associated with an increased risk for RA in both men and women when compared to non - smokers ( Sugiyama et al . , 2010 ) , and increased risk of MS ( in women stud - ied ) ( Hernan et al . , 2001 ) . Moreover , smoking has been found to be a risk factor for relapsing – remitting MS ( Hernan et al . , 2005 ) . Expo - sure to lower levels of sunlight ( Hammond et al . , 1988 ; Kurtzke et al . , 1979 ; Taylor et al . , 2010 ; van der Mei et al . , 2003 ; Vukusic et al . , 2007 ) , season of birth ( Dobson et al . , 2013 ; Willer et al . , 2005 ) , low maternal exposure to sunlight ( Staples et al . , 2010 ) , and low levels of vitamin D ( v"
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    ABSTRACT: Autoimmune diseases are a range of diseases in which the immune response to self-antigens results in damage or dysfunction of tissues. Autoimmune diseases can be systemic or can affect specific organs or body systems. For most autoimmune diseases there is a clear sex difference in prevalence, whereby females are generally more frequently affected than males. In this review, we consider gender differences in systemic and organ-specific autoimmune diseases, and we summarize human data that outlines the prevalence of common autoimmune diseases specific to adult males and females in countries commonly surveyed. We discuss possible mechanisms for sex specific differences including gender differences in immune response and organ vulnerability, reproductive capacity including pregnancy, sex hormones, genetic predisposition, parental inheritance, and epigenetics. Evidence demonstrates that gender has a significant influence on the development of autoimmune disease. Thus, considerations of gender should be at the forefront of all studies that attempt to define mechanisms that underpin autoimmune disease.
    Frontiers in Neuroendocrinology 04/2014; 35(3). DOI:10.1016/j.yfrne.2014.04.004 · 7.04 Impact Factor
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    • "In both menopausal and postmenopausal women, current smokers report increased odds of vasomotor symptoms, hot flashes, forgetfulness [7], and worsened HrQOL [8]. In MS, smoking has been linked to increased incidence [6] and faster MS progression [5] [9] leading to worse health outcomes [10]. More than 37 million women are approaching or experiencing menopause [11] in the aging U.S. population [12]. "
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    ABSTRACT: Background. In multiple sclerosis (MS), symptom management and improved health-related quality of life (HrQOL) may be modified by smoking. Objective. To evaluate the extent to which smoking is associated with worsened health outcomes and HrQOL for postmenopausal women with MS. Methods. We identified 251 Women's Health Initiative Observational Study participants with a self-reported MS diagnosis. Using a linear model, we estimated changes from baseline to 3 years for activities of daily living, total metabolic equivalent tasks (MET) hours per week, mental and physical component scales (MCS, PCS) of the SF-36, and menopausal symptoms adjusting for years since menopause and other confounders. Results. Nine percent were current and 50% past smokers. Age at smoking initiation was associated with significant changes in MCS during menopause. PCS scores were unchanged. While women who had ever smoked experienced an increase in physical activity during menopause, the physical activity levels of women who never smoked declined. Residual confounding may explain this finding. Smoking was not associated with change in menopausal symptoms during the 3-year follow-up. Conclusion. Smoking was not associated with health outcomes among post-menopausal women with MS.
    04/2014; 2014:686045. DOI:10.1155/2014/686045
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