Smoking and spondyloarthritis: a bad connection

independently associated with a higher BASDAI score (disease activity), and that increasing pack years were independently associated with higher mSASSS (radiographic spine damage), and a tendency with higher BASFI (function). These results are in accordance with the published data. But beyond these findings, the emerging question is the precise mechanism explaining the link between smoking and inflammation, disease activity, and new bone formation related to the disease. Several pathways may be followed and explored in this relationship. As recalled in the above-mentioned paper, smoking has an inflammatory effect through increased production of pro-inflammatory cytokines such as TNF-alpha and IL-6. In axial SpA, this was suggested by the finding of a smok ing dose-dependent rise of CRP levels [5]. Periodontitis may also play a role in the disease, as frequent association was noticed in several studies [9]. Smoking is associated with periodontitis and its severity in a dose-dependent manner and correlated with CRP elevation [10]. Smoking may also interfere with gut physiology. Gut involvement appears increasing in the pathophysiological