Living well with lupus

How does smoking affect people with lupus?

Thanks to a broad range of research studies, it’s clear that smoking complicates and accelerates the ill effects of lupus. We also know that most of the negative effects are reversible when smoking stops. In the Harvard Nurse’s Health Study, the authors conclude there are immediate benefits to discontinuing smoking and eventually the risk of coronary heart disease returns to the level of non-smokers.

More than any other lifestyle choice you make, quitting cigarettes will have the greatest positive impact on your lupus.

The following pairs what we know about lupus with the known effects of smoking.

Smoking and Infections

People with lupus are more susceptible to infections: Respiratory infections are among the most common. Smoking cigarettes increases the risk of pneumococcal pneumonia and chronic bronchitis. Researchers also report that passive smoking, or regular exposure to secondhand smoke, also raises the risk of having this type of pneumonia.

Smoking or being around people who smoke may increase your risk of pneumococcal pneumonia.

Smoking and Cardiac Complications

People with lupus on long-term moderate to high doses of prednisone have been found to develop heart disease (atherosclerosis) 20 to 30 years earlier than the general population. It's not uncommon for angina (heart muscle pain) and even heart attacks to occur in people with lupus as young as 30. Smoking increases the risk of coronary artery disease. Smoking also increases the risk of heart attack in diabetics (insulin or non-insulin dependent).

If you smoke and have lupus you greatly increase the risk of damaging your heart.

Smoking and Vascular Complications

Lupus can affect the blood vessels and circulation in a variety of ways.

  • Raynaud's phenomenon is common in people with lupus and when active, results in poor circulation to the hands and feet. Smoking contributes to blood vessel spasms and can magnify the effect of Raynaud's, making a mild case worse, and could result in severe damage to fingers and toes.
  • Lupus vasculitis can cause narrowing of blood vessels and reduced blood flow to tissues and organs. Smoking narrows blood vessels and worsens peripheral vascular disease (poor blood supply).
  • Antiphospholipid antibodies found in people with lupus may increase the risk of serious blood clots and stroke. Smoking also increases the risk of stroke. 

Smoking and Kidney Involvement

Smoking contributes to elevated blood pressure, which worsens kidney disease.

Kidney disease in lupus can result in hypertension. A study at Stanford University of individuals with lupus nephritis found that those who smoked progressed to end-stage kidney disease far more quickly than did non-smokers (145 months vs. 273 months).

Smoking and Digestive Issues

Smoking has harmful effects on all parts of the digestive system, contributing to such common disorders as heartburn.

Smoking and Liver Function

The liver breaks down many of the medications used to improve symptoms of lupus. Smoking affects the liver by changing the way it metabolizes drugs and alcohol. In some cases, this may influence the dose of medication necessary to treat an illness.

Smoking and Skin Involvement

Lupus can cause hair loss and other skin symptoms. Smoking has been associated with skin diseases. Studies in mice indicate a link may exist between smoking and both hair loss and premature gray hair.

Although lupus skin disease may be effectively treated with antimalarial medications, smoking has been shown to interfere with the benefits of drugs such as hydroxychloroquine (Plaquenil®) and chloroquine (Aralen®).

Studies conducted at Johns Hopkins University School of Medicine have found lupus skin disease is more active in smokers than non-smokers.

Smoking and Bone Health

Smoking slows bone healing. Meanwhile medications used in the treatment of lupus--such as prednisone, anticonvulsants, antacids containing aluminum, and heparin—increase the risk for fragile bones that lead to osteoporosis.

People with lupus can develop diabetes, making them prone to poor wound healing. Smoking slows wound healing even more.

Avascular necrosis of bone can develop in lupus and may require surgery. Smoking slows recovery from illness and surgery. 

Bottom line: It's never too late to quit!

Medically reviewed on May 28, 2013